Enterprise Zone Form B

All items must be completed on this form before the Effingham/Effingham County Zone Administrator submits an application to Illinois Department of Revenue for Building Materials Exemption Certificate on behalf of the contractor or project owner for the address declared on this application. Each contractor must have their own Building Materials Exemption Certificate issued by the Illinois Department of Revenue.

No building materials exemptions are allowed before the certificate date.

Learn more about the Effingham Enterprise Zone.

Project information
Name of project(Required)
Project address(Required)
Street Address Address Line 2 City State ZIP Code
Name of contractor business(Required)
Contractor business address(Required)
P.O. Box is not allowed.

Street Address Address Line 2 City State ZIP Code
Contractor’s Federal Employer Identification Number (FEIN)(Required)
If you do not have a FEIN number, you must go to the Illinois Department of Revenue website and apply for ID # before this application may be processed.
Contact person for this certificate(Required)
First Last
Contact phone(Required)
Contact email(Required)
IDOR will email your BMEC when issued to this email.
Enter Email Confirm Email
Contractor’s completion date:(Required)
This is the estimated date your portion of the project will be finished purchasing and/or ordering materials for your portion of the project. Please allow yourself a bit of overage time as weather and delays can change when you expect to be complete. Date declared will be expiration of Certificate.
Cost estimates
Total contract amount (materials and labor)(Required)
Estimated amount of building materials for this contract(Required)
Percentage of contract that is building materials
This is calculated by dividing the estimated building material cost by the estimated total contract cost.
Consent(Required)
I hereby make an application for an enterprise zone building materials sale tax exemption certificate to be provided by the Illinois Department of Revenue. I agree to be responsible for the use of this certificate. I attest that this certificate will only be used on the project that it has been applied for. I agree that this certificate cannot be used on any purchases not related to this project. I agree to comply with all annual reporting requests from the Illinois Department of Revenue. I acknowledge that all reporting must be done by May 31 of the year following the material purchase. In the event the reporting is not done, the Illinois Department of Revenue has the right to rescind your certificate and the Effingham Enterprise Zone administrator has the right to deny future certificate until reporting has been completed.

By typing your name below and clicking on “I Agree” below, you acknowledge and agree to the following:
• I have read, understood, and agree to the terms and conditions of the Enterprise Zone Building Materials Sales Tax Exemption.
• I agree that my electronic signature is the equivalent of a manual signature and that the City of Effingham, Illinois, may rely on it as such in connection with any and all agreements that I may enter into with the City of Effingham, Illinois, and any documents I electronically sign for the City of Effingham, Illinois;
• I acknowledge and agree that it is my obligation to immediately advise the City of Effingham, Illinois of any change in my electronic address (i.e. email address);
• I acknowledge and agree that it is my obligation to immediately advise the City of Effingham, Illinois, in the event I withdraw my consent to use electronic means for the application and/or account;
• I acknowledge and agree to the terms and conditions contained within the Online Application E-Signature and Electronic Disclosure Agreement
• I acknowledge and agree that the various security and verification procedures adopted by the City of Effingham, Illinois, in connection with the Enterprise Zone Building Materials Sales Tax Exemption form (Form B), as well as any other documents that I will affix my electronic signature constitute reasonable and secure security procedures and that all signatures are attributable to the person whose name is typed below;
• I acknowledge and agree that the individual completing this Enterprise Zone Building Materials Sales Tax Exemption form (Form B) is the individual who will be purchasing building materials. By typing your name below, you understand that you are electronically signing this document and are agreeing to all of the policies, terms, and conditions set forth above. You further understand that the City of Effingham, Illinois, will rely upon your electronic signature to the same extent as if you had signed this document in ink. If you do not understand or accept or agree to the policies, terms, and conditions set forth above, then Do Not click on the “I Agree” button and exit this site.

I agree to the terms and conditions.
Electronic signature (your name)(Required)
First Last
Today's date(Required)
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Project information

Cost estimates

Reporting requirements by law