Distributorship Application

 
     
Salutation: *
Company Name: *
First Name: *
Last Name: *
Address1: *
Address2: *
City: *
County/District: *
State: *
Zip/Postal Code: *
Country: *
 
Business Phone: (with area code)  *  
Cell Phone: (with area code)  *
Email: Very important *
Referred BY? *  
Which product (s) are you seeking? *  
     
What's the best time to reach you? *  
     
Estimated strat up date: *  
     
Enter desired county and state you wish to start: *   Choice #1

County:

State:

Country:
     
Enter your desired county and state you wish to start: *   Choice #2 (if 1st choice is unavailable)

County/District:

State:

Country:
     
Will you be operating your route on a full-time or part-time basis? : *   Full-Time Part-Time
     
Enter your educational background: *  
     
Enter your proffessional experince: *  
     
Enter 3 reasons why you think this is a good business: *  

1.

2.

3.

     
How are you able to acquire the funds neccessary to operate your distributorship? : *  
     
Enter your approximate net worth: *  
     
(requited) : *   3 Business References
     
Full Name : *  
Phone number (with area code) : *  
How long known? *  
Full Name : *  
Phone number (with area code) : *  
How long known? *  
Full Name : *  
Phone number (with area code) : *  
How long known? *  
     
Please explain in your own words to the board of directors, why you feel you would make a good distributor for Distributorship.com: *