Application form Name (last, first, middle initial) Salon name Salon street address City State Zip Telephone Work Home Cell Fax E-mail address Web site address, if applicable Title/Role Owner Manager Other No. of years as a licensed cosmetologist No. of years in business at this salon Total no. of years in business No. of employees Sales volume $0-100k $100-250k $251-500k $501k+ Hair coloring technical skills rating Excellent Good Training is needed Are you agreeable to having your hair coloring skills evaluated? Yes No Are you agreeable to participating in our ongoing hair color education program? Yes No Brand of hair coloring products currently used Product advantages/disadvantages Brand of hair treatment products currently used Product advantages/disadvantages Please give a brief description of why you are interested and why your salon would be a good fit for this licensing opportunity. Description

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