Full Name

Business Name (if applicable)

Phone Number

Email Address

Business Address (or service area)

City, State

Zip Code

Do you work Independently or with a salon/spa? Do you work Independently or with a salon/spa? Independent Salon/Spa

If Salon is selected, please enter the name of it here

Website/Social Media Links (if applicable)

Beauty Services Offered (select all that apply) Beauty Services Offered (select all that apply) Hair Styling & Cutting Hair Coloring & Treatments Braiding & Protective Styles Makeup Artistry Skincare & Facials Brow & Lash Services Nail Care (Manicures & Pedicures) Barbering Personal Stylist Massage Therapy Waxing & Hair Removal Other

If 'Other' is selected, please enter the service here

Do you have a valid beauty professional license in your state? Do you have a valid beauty professional license in your state? Yes No

License Number

Issuing State

Expiration Date

Do you carry professional liability insurance? Do you carry professional liability insurance? Yes No

How many years of experience do you have? How many years of experience do you have?0-2 Years3-5 Years6-10 Years10+ Years

Are you currently accepting new clients? Are you currently accepting new clients? Yes No

Preferred Payment Method for Payouts: Preferred Payment Method for Payouts:Direct DepositPayPalBusiness Bank Account

What areas are you willing to travel to for appointments? What areas are you willing to travel to for appointments?Local OnlyWithin 10 MilesWithin 25 MilesStatewide

Availability for Bookings (Check all That Apply) Availability for Bookings (Check all That Apply) Weekdays Weekends Mornings Afternoons Evenings

Electronic Signature

Date