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Potential Coaster Dealer Application
Business General Information
Business Name *
Website
Number of Stores*
Average size of store (sq. ft.)
Owner Name *
DBA *
Business Phone *
- - Ext
Business Fax
- -
Business Address *
Address 1
Address 2 (optional)
City
State
Zip Code -
Shipping Address *
Address 1
Address 2 (optional)
City
State
Zip Code -
Primary Contact
Contact Name *
Email *
Title *
Work Phone *
- - Ext
Cell Phone
- -
Sales Rep#
Sales Rep Email
Business Operations
Bussiness Type:
Do you operate in more than one State?
Payment Methods:
Do you want to setup a Coaster Retail Connection?
Do you want a Data Feed from Coaster?
Coaster Warehouses
Please select the nearest Coaster's warehouses. Please check at least one. *
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12909 Sandoval Street
Santa Fe Springs CA 90670
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9698 W Sugar Rd
Tracy CA 95304
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14901 Grand River Road;
Fort Worth TX 76155-2733
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1550 Central Ave
Roselle IL 60172
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45 Stults Road Suite 2;
Dayton NJ 08810-2516
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10700 Enterprise Way
Miramar FL 33025
Affiliations & Requirements
Industry Group Affiliations
Special Requirements
By completing this on-line Application and Forms, I am agreeing to Coaster Terms and Conditions