Today's Date _____-_____-_____
Your Name: ___________________________________________________ (first, middle, last)
Address: _______________________________________________________________
City: _____________ State: ___________________ Zip: ________________
Night Phone: (_____) _______-________ Cell Phone: (_____) _______-________
Day Phone: (_____) _______-________ E-Mail Address: ______________________@_________________
Current Place of Employment: ____________________________________________________________
Current Employer's Address: _____________________________________________________________
Supervisor's Name: ___________________________________ Date Started _____-_____-_____
Supervisor's Phone: _______________________________________
Are you still employed here? Yes ____ No ____
May we contact your current employer? Yes ____ No ____
Combined Annual Household Income: (Please circle one)

Bank References:

Bank: _________________________________ Bank Representative: __________________________
Bank Telephone number : (____)_____-_______
Bank Address: _____________________________________________________________________
Account Number: ________________________________
Does your bank offer Credit Card Set-up for processing your credit card sales?

Personal References:
Name _________________________________________ Phone (_____)______-_________
Name _________________________________________ Phone (_____)______-_________
Name _________________________________________ Phone (_____)______-_________

The undersigned agreed that the above information provided is correct to the best of their knowledge. The undersigned agrees that if their application is approved they will commit to a minimum of two trunk shows per year. Location used for the show must be clean and reputable.

Samples must be treated with care so that other "fashion stores" unsing the samples receive the samples in excellent condition. If zippers are broken or beads fall off, the below agrees to take the dress to a tailor for fixing before sending to the next store. The undersigned agrees to conduct their fashion store business in a prorfessional friendly manner to the best of their ability.

The undersigned agrees that they are 16 years of age or older.

__________________________________________ _____-_____-_____
signature and date

If under the age of 18 a parent or guardian must sign this form also. They agree that they are responsible for the above trunk show.

__________________________________________ _____-_____-_____
signature and date

Sign and enclose deposit of $2,500. Deposit can be paid by person check, money order, cashier's check or credit card (Visa, MasterCard, Discover Card, or American Express).

Credit card number _____-_____-______-______ exp date _____/______
3-digit number on the back of the card ___________

Mail or e-mail to:

PromDressShop.com
501 S Lake Avenue Ste 102
Duluth, MN 55802