Dealer application - Coaster Fine Furniture

I’m interested in becoming a Coaster Brick & Mortar dealer

Owner First Name *

Owner Last Name *

Email *

Fax

Phone *

Mobile Phone

Address *

Address Line 2

City *

State *

Zip Code *

Country *

Legal Business Name *

DBA (Doing Business As)

Company Website *

Sales Tax Certificate # *

Number of Stores *

Average Size of Store(s) (sq. ft)

Type of Business *

Type of Products Selling * (please check all that apply)

Furniture

Mattresses

Electronics/Appliances

Other

If other please specify

Years in Business *

Annual Sales Volume *

Other Furniture Brands You Represent

Nearest Distribution Center *

Notes/Comments