Bellalina
Bellalina Date______________
Whole Name___________________________________________
Whole Address_________________________________________
_____________________________________________________
Home Phone___________________________________________
Cell Phone____________________________________________
E-mail address_________________________________________
Date of Birth__________________________________________
Social Security #_______________________________________
Recruiter’s Name_______________________________________
Owner’s Signature______________________________________
By my signature below, I verify that the information above is correct. I have read the Independent Sales Rep Guide and agree to follow all the guidelines I have read. I fully understand that if I break the agreement I will no longer be working for Bellalina.
Your Signature__________________________________________
Lindsay Harris
P.O. Box 17
Lamar, MO 64759