Area 51 Racing Dealer Application Please Note: Navigating away from this page before you complete and submit may erase all data entered. To download a paper version of this application click HERE. Please fill out completely and FAX to (707) 258- 1611. Date (mm/dd/yyyy)*Legal Name* First Last Doing Business As (D.B.A.)*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone*Business FaxPrincipal Owner's / Officer's Name* First Last Parts Manager's Name First Last Accounts PayableWebsite Email* Date Business Started (mm/dd/yyyy)*Days and Hours of Operation*RESALE CERTIFICATE INSTRUCTIONSIn order to comply with sales and tax laws, it is necessary that we have properly completed Resale Certificate from all our customers who claim a sales tax exemption for products that have been purchased for resale. In the space provided for the “Description of Property“ please choose either: 1.) A list of the particular products to be purchased for resale. 2.) A general description of the kind of products to be purchased for resale. THE UNDERSIGNED HEREBY CERTIFIES: I HOLD VALID SELLER'S PERMIT NUMBER* (You must enter your seller's permit number)*Issued pursuant to the Sales and Use Tax Law and that I am in the business of selling:*That tangible personal property described herein which should I should purchase from Area 51 Racing. Will be resold by me in the form of tangible personal property, provided however, that in the event any such property is used fro 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 State and Use Tax Law to report and pay tax, measured by the purchase price of such property or . Description of property to be purchased.ISSUED PURSUANT TO THE SALES AND USE TAX LAW AND THAT I AM IN THE BUSINESS OF SELLING:* A list of the particular products to be purchased for resale. A general description of the kind of products to be purchased for resale. *A certificate thus describing the products is good until revoked in writing. Printed Name of Purchaser* First Last Entering of your name and submitting this form will serve as an electronic signature.* First Last Date (mm/dd/yyyy)*CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.