RBS Wig Studio Professional Prospect Information Form

RBS Wig Studio Professional Prospect Information Form

Thank you for your interest in working with us. Please provide the following information to get started.
Position Applying for*

Salon ProWig StylistVirtual ConsultantIn-Studio Consultant
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Business Name (if applicable)
Business Address (if applicable)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Tax Filing Status*

Individual/Sole ProprietorC CorporationS CorporationPartnershipTrust/EstateLimited Liability Company (LLC)
Description of Services Currently Offered*
Available to Start Date*

MonthDayYear
Date
Do you have a business license?

YesNo
Are you currently engaged with other clients?*

YesNo
Have you worked with clients/patients experiencing medical related hair loss before?*

YesNo
Insurance Information
Do you have liability insurance?

YesNo
Policy Number
Policy Expiration Date

MonthDayYear
Date
Additional Notes or Comments
I certify that the information provided in this form is true and accurate to the best of my knowledge. I understand that providing false information may result in the termination of my contract.
Date

MonthDayYear
Date
Signature

Clear
CV UPLOAD

Cancelof
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