Dealer Application Form Instructions:
To insure prompt processing of this application:
Print out Dealer Application and State Resale
Tax I.D. Form
Fill out all
of the requested information (Note: some states/countries may not
have all of the required information, please indicate N/A if not available)
Copy of your Resale license or business license.
WE MUST HAVE A COPY
OF THE ACTUAL LICENSE.
Photos of your business – 1 inside, 1 front view
with signage. (may be e-mail
separately)
Fax all information to:
Or Send via mail to:
Note: We review dealer applications daily. We look
forward to evaluating your
application. First order minimum purchase may be required.
DEALER
APPLICATION
BUSINESS NAME _________________________________________________
ADDRESS_______________________________________________________
CITY___________________________ STATE_______ ZIP________________
PHONE __________________________ FAX ___________________________
FEDERAL TAX I.D. #_______________________
STATE RESALE #_________________________
BUSINESS LICENSE #____________________
WEBSITE (if available) _____________________________________________
E-MAIL (if available) _______________________________________________
CONTACT PERSON _______________________________________________
DESCRIPTION OF BUSINESS: (Merchandise sold, square footage, etc.)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
YEARS IN BUSINESS ________ NUMBER
OF OTHER LOCATIONS ________
Please include names, addresses and
phone numbers of other accounts and references.
1.____________________________________________________________________
2.____________________________________________________________________
3.____________________________________________________________________
________________________________________________________________
PRINT
NAME OF OWNER(S) OR AUTHORIZED OFFICER
SIGNATURE
___________________________________ DATE
____________20____
STATE
RESALE TAX I.D.
FIRM NAME
___________________________________________________________
I HEREBY CERTIFY, that I hold valid
seller's permit No._________________________
Issued pursuant to the Sales and Use Tax Law; that I am engaged in the business
of selling
______________________________________________________________________
and that the property purchased from Pacific
Coast Star will be resold by me in the
regular course of business. It is understood that I am required by the Sales
and Use Tax
Law to report and pay for the tax, measured by the purchase price of such
property.
LaMans®, Parts Unlimited®/ Drag
Specialties®/ Slippery®/ Thor®/ Thormax®/ Moose®/ Moose
Racing®/ Moose Utility Division®/ Moose ATV Hunting Products®/ Python®/ Icon®/
Trukke®/
Wingleaders®/ Zir®/ Arctiva®/ Ams tires® trade named products are
not available through the
PCS dealer network.
SIGNATURE
___________________________________ DATE
____________20____
WE MUST HAVE AN ACTUAL COPY OF
YOUR BUSINESS LICENSE OR RESALE
LICENSE IN ORDER TO ACCEPT YOUR APPLICATION.