Bio~Therapeutic Education, Equipment, and Skin Care for being™

Sales Consultant Registration Form
Company Info
Company Name:
Years in Business:
Address:
City:
State:
Zip:
Phone:
Signer / Guarantor:
Title:
Nature of Business:
Personal Information of Officers, Partners, or Guarantors
Company Name:
Years in Business:
Address:
City:
State:
Zip:
How Many Years::
Drivers Lincense Number::
Title:
Trade References: Companies you have conducted business with for at least two consecutive years
Reference 1
Name:
City:
State:
Phone:
Contact:
Reference 2
Name:
City:
State:
Phone:
Contact:
Reference 3
Name:
City:
State:
Phone:
Contact:
Equipment/Product Range Information
Purcahse Capacity	Full Purchase Authority Purchase Input No Purchase Authority
Products of Interest	Bio-Ultimate Platinum Face Bio-Ultimate Platinum Face and Body Bio-Synthesis Bio-Brasion Bio-Oxygen Bio-Dermolgy bTCeuticals Accelerated Skin Care
What type of equipment do you currently represent?
What product(s) do you currently represent?
Sales Information
How many sales executives do you currently have?
How many locations do you currently have?
What territory(s) do you currently represent?
What is your annual volume?
How many current accounts do you have? How many of them own equipment?
Do you have an education department? If yes, please indicate the number of active educators:
How many trade events do you participate in per year? How many trade advertisements do you participate in each year?
How would you best describe your sales?	Trade Events Online Web Orders Consultants in the Field Phone Sales Education Events Onsite Visits Other:
Your contact information will not be sold or shared with third parties.

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