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Stylist Information

* Required

First Name *

Last Name *

Cell Phone Number *

Email Address *

Cosmetology License # *

Home Address *

City *

State *

Zipcode *

Position in Company *

Can you purchase and sell products for retail independent of the salon?

Please note approval from the Salon Owner is required

Is this a Home Salon? *

Salon Name *

Salon Owner's Name *

Salon Business License # *

Salon Phone Number *

Salon Address *

Salon City *

Salon State *

Salon Zip Code *

Country *

Preferred Ship To Address *

How did you hear about us? *

What is your salon's website? *