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Day
2012
Year
Visit Date
To register with us please complete the fields below
First Name:
Last Name:
Male:
Yes
No
Female:
Yes
No
Home Address:
Shipping Addr (if different)
City:
Pick State
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State:
Zip:
Home Phone
Daytime Phone
Cell Phone:
Fax:
E-Mail Address:
List other States you service:
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Zip codes you can cover:
Please, only ONE zip code per field
One Zip Code:
One Zip Code:
One Zip Code:
One Zip Code:
One Zip Code:
One Zip Code:
One Zip Code:
One Zip Code:
One Zip Code:
One Zip Code:
2.   Please answer the following:
A.  Merchandising
If you have Merchandising experience, check Yes.    
Yes
No
If you do not have Merchandising experience but     
would like to be considered, Check yes     
Yes
No
B.  Re-sets and Plan o Grams
If you have experience in reading Plan o Grams     
and executing Re-Sets, Check yes.     
Yes
No
If you do not have experience in reading Plan o Grams and      
executing Re-sets but would like to be considered, Check YES      
Yes
No
C.   Installations
If you have experience with installations which can include      
lifting up to 50 lbs, check yes       
Yes
No
If you do not have experience in installation work but       
would like to be considered, check yes       
Yes
No
D.   Mystery Shopping
If you have experience in mystery shopping, check yes       
Yes
No
If you do not have experience in mystery shopping but       
would like to be considered, check here       
Yes
No
E.   Demonstrator
If you have experience as demonstrator, check here       
Yes
No
If you do not have experience as demonstrator but       
would like to be considered, click yes       
Yes
No
If you have additional comments please list here.
Comments:
Quit without submitting report