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Ultra-Balm New Store Rep 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.)

Number Of Sales People In Company:

CONTACT INFORMATION

Phone Number:  Fax Number: 

Physical Address: 

City:  State:  Zip Code: 

Email Address:

Website:

Are you currently using Ultra-Balm?  

What are the top 3 things you like about Ultra Balm in order of priority:
1.)

2.)

3.)

Do you have any previous sales rep experience (when & what product(s) or product line(s)) where (city/state):

Are you currently a Store Rep for any other products? If so what product(s), what type of stores:  

Number of Years Representing:

What city and or state might you be interested in representing our products in:

In what type of retail outlets might you be interested in selling Ultra Balm to:

Additional Comments and/or Queries:

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:  


                

 
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