Please fill out this form completely, BOLD fields are required!(DO NOT HIT RETURN - THIS WILL SEND THE FORM!)
Date:
Company Name: (If none please skip)
Authorized Buyer:
Referring By, If Any: NONE Internet Promotion Jessica Avila Vicki Basar Lisa Bass Melissa Bater Elizabeth Chu Katrina Davalos / Arizona Michael Farris Joy & Daniel Hagenhoff Bruce Johnson N. David Kollander Tenzinz Limbu / Canada Teresa Lai / Hawaii Merry Lou Pat Marks Ron McKee Popeye Merrifield Brandi Nichols Pik-A-Tee Plus, Inc. Scott Reed Sabastian Rodriguez Mark & Sue Strasser Linda Taylor Rhonda Weiand JoLynn Wright (There is never an additional cost with referral.)
CONTACT INFORMATION
Phone Number: Fax Number:
Physical Address:
City: State: Zip Code:
Email Address:
Website:
Are you currently using Ultra-Balm? No Yes!
Do you have any previous selling experience (when & what product or product line) where (city/state):
Are you currently selling any other products? If so, what, how and where? (home sales; neighborhood sales; internet sales; retail shows or to stores):
Are you or have you ever sold demonstration products (when, where and what):
Number of Years Selling: 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20+
How and where would YOU like to sell Ultra-Balm?
Additional Comments:
Thank you for completing our application and we appreciate your interest in our products. Expect a call from us shortly to explore your future with Ultra Balm!
When is the best time to contact you: Early Morning: 5AM - 8AM Morning: 8AM - 11AM Mid-Day: 11AM - 1PM Afternoon: 1PM - 5PM Evening: 6PM - 9PM