Ultra Balm Header
Ultra-Balm Home Parties
Seller Application

 

  

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: 

Referred By, If Any: 
(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?  

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:

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:  


                

 
Unauthorized use is a willful infringement upon rights under 17 U.S.C. Section 101 et seq.
You will be held liable for statutory damages as high as $150,000 for each occurrence as set forth in Section 504 (c)(2) therein.
All Original Images © Copyright, www.UltraBalm.org, 2006-2010