Distributors Eligibility Verification Form

Please fill this form out to be considered for a Mizutani representative in your area. See “Domestic Service Location and Distributors” in the “Support” section of this website before sending this form in. Mizutani representatives are wanted, however opportunities are limited to cities where there is currently no representative.

Candidate's Name *

Hairdresser Experience *

Yes

Sharpener Experience *

Yes

# of Years Experience *

Candidates Last Job Title Confirmed As *

Candidates last Rate of Pay Confirmed As *

Email *

Phone *

Address *

City *

State *

Zip Code *

If Approved as an Authorized Distributor, which state do you intend on claiming as your area of service? *

If Approved as an Authorized Distributor, which cities do you intend on claiming as your area/areas of service? *

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