Screen Concepts, Inc. :: B2B :: Business Opportunities Process

PERSONAL INFORMATION:

*Name:**
Soc Sec No.:
Date of Birth:
Street Address:
City:
State:
Zip Code:
Home Phone:
Business Phone:
May we contact you at your business? Yes No
*E-mail:**
Current Job and Position:

BACKGROUND:

Geographic area of interest in order of preference:
1st Preference:
2nd Preference:
3rd Preference:
How will you finance your distributorship?
Do you have distributorship or sales management experience? Yes No
If Yes, please provide details:
If No, please let us know who will be your operator/supervisor and provide details as to that person's background:
Do you or your spouse currently own any interests in any home improvement product or service business? Yes No
If Yes, please provide details:
How did you learn about Screen Concepts?