Dealer Application

SECTION 2: LEGAL & TAX DOCUMENTATION

Employer Identification Number (EIN):

Business License Number:

State Resale/Tax Exemption Certificate Number:

State of Incorporation:

File Uploads Required:

Attach when submitting this form

Business License

Tax Exemption/Resale Certificate

W-9 Form

SECTION 3: PRIMARY CONTACT INFORMATION

Full Name:

Title/Position:

Email Address:

Direct Phone:

SECTION 5: TRADE REFERENCES (Optional but recommended)

Reference 1

Company:

Contact:

Phone:

Email:

Reference 2

Company:

Contact:

Phone:

Email:

SECTION 6: AGREEMENT & SIGNATURE

By signing below, I confirm the information provided is accurate to the best of my knowledge. I understand that this application is subject to review and does not guarantee approval.

I agree to the terms and conditions of the Dealer Program.

Signature:

Date:

Printed Name:

If you have questions or need assistance, please email: sales@crossroadgaragellc.com or call 509-306-9577