Interested in becoming a Coaster retailer or Ecommerce dealer? Please fill out the form below and we’ll get back to you as quickly as possible.
Please Select One * Brick & Mortar and Ecommerce Dealer
Owner First Name *
Owner Last Name *
Email *
Fax No.
Phone *
Mobile Phone
Address *
Address Line 2
City *
State * Please Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip Code *
Country * Please Select CountryUnited StatesCanadaMexicoUnited Kingdom-----AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArmeniaArubaAustraliaAustriaAzerbaijanAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaireBosnia and HerzegovinaBotswanaBouvet Island (Bouvetoya)BrazilBritish Indian Ocean Territory (Chagos Archipelago)British Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCuraçaoCyprusCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKazakhstanKenyaKiribatiKoreaKoreaKuwaitKyrgyz RepublicLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Netherlands)Slovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & S. Sandwich IslandsSpainSri LankaSudanSurinameSvalbard & Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsU.S. Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe
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 * Please Select OneEcommerce and Brick & MortarEcommerce OnlyRent to OwnDesigner/StagerDistributorLiquidatorWarehouse/ClubOther
Type of Products Selling * (please check all that apply) FurnitureMattressesElectronics/AppliancesOther
If other please specify
Years in Business * Please Select OneLess Than 11-22-55-10More Than 10
Annual Sales Volume * Please Select OneLess than $500K$500K - $1M$1M - $4.99M$5M - $19.99M$20M +
Other Furniture Brands You Represent
Nearest Distribution Center * Please Select OneAtlanta (4300B South Fulton Parkway, College Park, GA 30349)Chicago (255 Willie Rd, Des Plaines, IL 60018)Florida (10700 Enterprise Way, Miramar, FL 33025)Santa Fe Springs (12909 Sandoval St, Santa Fe Springs, CA 90670)New Jersey (45 Stuits Rd, Suite 2, Dayton, NJ 08810)San Francisco (8350 Pardee Dr, Suite 200, Oakland, CA 94621)Texas (14901 Grand River Rd, Fort Worth, TX 76155)Drop Ship From All 7 Distribution Centers
Industry Memberships (please check all that apply) BrandSourceHFAFMGFurniture FirstNationwideTRIBIAHSPRESAOther
Online Marketplace(s) You Sell On (please check all that apply) AmazonWalmartJet.comEbayEtsyGoogle ShoppingSears MarketplaceOverstock.comNewEgg.comRakutenOther
Other Ecommerce Sites You Sell On (i.e. non-marketplace(s))
Percentage of Business Through Ecommerce
%
Do you handle freight to consumers? * YesNo
Do you handle large item delivery via LTL? * YesNo
Do you handle small item delivery via Small Parcel Courier? * YesNo
Marketing Strategy
Notes/Comments