Pre-Qualification Form
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Desired Date to Begin Lease
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Desired Suite
Please Select
Model 1 - Mini Deluxe Suite
Model 2 - Single Deluxe Suite
Model 3 - Single Premium Suite
Model 4 - Double Deluxe Suite
MOdel 5 - Double Premium Suite
Years in the beauty industry
Are you an Owner, Booth Renter or on Commission?
Please Select
Owner
Renter
Commission
Weekly Booth Rent ($)
Commission Pay Scale
Services (%)
Retail (%)
Are your current gross weekly service totals?
Please Select
Less than $1000
$1000 to $1800
$1800 to $2400
$2400 to $3000
Over $3000
Are you considering a partner?
No
Yes
Question or Comment? How did you hear about us?
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