Distributor Request Form

Full Name *
Email *
Direct Phone *
What City/State are you located in?
Will this be your only product line *	Yes No
What product(s) are you interested in?
Are you a user of Divine Virgin Hair *	Yes No
What grade of hair are you interested in?
What texture of hair do you anticipate selling the most?
What is your desired delivery turnaround time?
How often do you anticipate ordering?
What is your projected amount of bundles ordered per month?
What is the most important factor in becoming a distributor?
What is your greatest concern in dealing with other vendors?
What is the key to you being a strong distributor of Divine Virgin Hair? *
Are you a member or affiliate of E3 Business Group, Inc. *	Yes No
If yes, please list the nearest Chapter of E3
What is the best method and time to reach you?
May we add you to our email distribution? *	Yes No