STAMP N
PLUS SCRAP N
P.O. Box 47 Chippewa Falls, WI 54729 (715) 271-1873
www.powderedchalk.com
www.stampaffair.com
INDEPENDENT REPRESENTATIVE APPLICATION
Full Name:
_____________________________________ Social
Security No.:
Shipping Address (No PO Box)
____________________________________________________
City:
State:
Zip:
______
Home
phone:
Work phone: ______________ e-mail:______________________
Birth
date:
Tax rate:
________________
Have you ever been a Home Party Demonstrator before?
If
yes, which company(ies)?
Type of products sold:
List
hobbies, skills or training:
___________________________________________________
___________________________________________________
___________________________________________________
List
three references:
Name
Address
Phone
1.
__________________________________________________________________
2.
__________________________________________________________________
3.
__________________________________________________________________
Current
or most recent job information:
Company
Name:
Title: ____________
Company address:
Job Description: Phone
No.:
Recruiter
Information:
Name:
Recruiter
No.:
Address:
Phone No.:
City:
State:
Zip:
I
certify that the facts in this application are true. I have read the Representative Agreement and understand and
will follow all the policies and procedures to become a Representative.
Signature:
Date:
FOR
OFFICE USE ONLY
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Application
Approved:
Date:
By:
Representative #
Comments: