First Name:                     Last Name:
            Address:                             City:                          State:      Zip:
             
    Email Address:
    
    Phone Number:                   Ext:
        

    1: Are you a licensed professional?:      Select One Yes No

    2: What is your area of specialization?:      Select One Hair Nails Skin

    3: How long have you been a beauty professional?:   year(s)

    4: Approximately how many clients do you service on weekly basis?:  

    5: What percentage of your customers are repeat clients?:      Select One 25-50% 50-75% 75%+

    6: Your current weekly income is between:      Select One $500-800 $801-1000 $1001-$1500 $1501+

    7: How did you hear about Indivi Salon Suites?:      Select One Mail Newspaper Internet Referral Other
        If "Other", please specify:  

    8: Are you interested in receiving more information about Indivi Salon Suites?:          Select One Yes, via mail Yes, via e-mail (please provide email above) I would like to receive a phone call

    9: Where would you like to see Indivi Salon Suites?:      Select One Alpharetta/Roswell Buckhead Cherokee County Dekalb County Douglasville Downtown Atlanta Dunwoody East Cobb Gwinnett Midtown North Cobb North Fulton Vinings Virginia Highlands Other
        If "Other", please specify:  

    Comments or Questions: