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:

Pacific Coast Star at (509) 466-3475

*  Or Send via mail to:

Pacific Coast Star
3915 E Francis Ave #C10
Spokane, WA 99217

 

 

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.