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 FORM
BUSINESS NAME _________________________________________________
PHONE __________________________ FAX ___________________________
ADDRESS________________________________________________________
CITY___________________________ STATE______ ZIP________________
FEDERAL TAX I.D. #_______________________
STATE RESALE #_________________________
BUSINESS LISCENCE #____________________ or add in yellow
pages.
WEB SITE (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._______________________________________________________________
__________________________________________
NAME
OF OWNER(S) OR AUTHORIZED OFFICER
SIGNATURE ____________________________ DATE ____________20____
STATE
RESALE TAX I.D. FORM
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.
Name/Title _______________________________
Address _____________________________________
State _____
Zip ________
Signature ______________________________Date ______20____
WE
MUST HAVE AN ACTUAL COPY OF YOUR BUSINESS LICENSE OR RESALE
LICENSE IN ORDER TO ACCEPT YOUR APPLICATION.