Dealer ApplicationTarek L2017-05-12T19:02:08+00:00 Dealer Application Business Name*Buyer Name* First Last Email* Phone*FaxBusiness Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website Address Type of Business*Number of years in business*Are you an online reseller?*YesNoAre you an interior designer?*YesNoDo you have a wholesale business?*YesNoIf you are an online reseller, what is your website address?* Please complete the following Blanket Certificate of Resale:Business Name/Owner nameBusiness Address:My valid seller’s permit number isIssued pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling:that the tangible personal property described herein which I shall purchase from PPD will be resold by me in the form of tangible personal property; provided, however, that in the event of such property is used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of business, it is understood that I am required by the Sales and Use Tax Law to report and pay tax, measured by the purchase price of such property or other authorized amount.Description of property to be purchased:By checking this box, you accept it as a substitute for the Signature of Purchaser or Authorized Agent Yes I accept Printed Name/Title:Telephone number:Date *Our emails may end up in your SPAM or Junk Mail folders by mistake- please check there, especially after placing your online order.