BECOME A DISTRIBUTOR
Contact Information
Full Name (Required): Phone Number (Required): Email Address (Required): Mailing Address (Optional):
Preferred Contact Method: PhoneEmail
Business Background
Company Name (Optional): Company Address (Optional):
Are you currently or have you previously worked as a distributor in the beauty industry? (Required) YesNo
If yes, which brands have you represented: If yes, which areas have you covered:
Distribution Profile & Interest
What type of client do you primarily serve: Professional salonsBarbershopsBeauty Supply StoresOnline / E-commerceOther:
How many sales reps do you currently work with: None1-23-5More than 5Brick-and-mortar only
Do you currently operate a warehouse or distribution center: YesNo
How did you hear about Nirvel: Trade show/ExpoSocial mediaAnother distributorIn a professional salonOther
Which territory would you be interested in representing Nirvel in? (Required): Why are you interested in representing Nirvel Professional: Please share any additional information you believe is relevant for becoming an official Nirvel USA distributor:
Consent and Submission
Consent to Process Information (Required): I consent to Nirvel Professional processing my personal data
Signature (Required):
Date (Required):
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