NEW REPRESENTATIVE INFO: FULL NAME______________________________________ FULL ADDRESS___________________________________________ SHIPPING ADDRESS___________________________________________ CELL PHONE NUMBER________________________ EMAIL ADDRESS_____________________________ SOCIAL SECURITY NUMBER_______________________ BIRTH DATE______________________ HAVE YOU EVER SOLD AVON BEFORE? YES OR NO (CIRCLE ONE) COMPANY USE ONLY…. DISTRICT#____________ ACCT # _____________ REF CODE:____________ UPLINE:___AIDEN BEAN____ E-STORE:____________________ CASH____ CREDIIT____ CREDIT CARD #_________________ EXP DATE:____________ CVV #:___________
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