AVON Appointments

Branch A = Atl District Acct# Title Mrs (1) First Name MI Last Name
M = Mgr Ms (2)
N = Nwk Miss (3)
P = Pas Mr (4)
Mailing Address: Number and Street City State Zip Yrs at Current Address
1 = Less than 1 Year
2 = 1 to 8 Years
Shipping 3 = 9 or More Years
Address Shipping Address: Number and Street City State Zip Residence
If Different
Than O = Own
Mailing R = Rent
L = Live with Others
Special Instructions for Delivery Applies Home Phone Work Phone
S = Shipping
M = Mailing

Email Address example: You@aProvider.com Social Security or Tax ID # Birth Date Test Tag

Source of Income Employed By/Other Driver's License? Driver's License # Classification of Origin (optional) Office Use
1 = Alimony 3 = None W = White B = Black
2 = Employed 4 = Retired Yes A = Asian O = Other
5 = Other H = Hispanic
Bank Type Bank Name Bank Address
C = Checking S = Savings
B = Both

Credit Card Other Last 4 digits of Credit Card Acct # Exp

A = American Express M = Master Card
D = Discover V = Visa O = Other

If Yes, When? Where? Previous District Previous Acct #

Did You Sell Avon before? Yes

Appointment Maker Acct # Cmp of 1st Order Appointment Date Appointment Source
1 = DSM 2 = FWS 3 = UL 7 = MARKSA Appointment Maker 1 = Rep 2 = Non-Rep
4 = ADV 5 = EXEC. 6 = SR EXEC 8 = N/A in training? Yes 3 = DSM 4 = Other

Appointment Fee Amt$ Credit Card Credit Card Number Exp Approval Code
3 = Full 4 = Credit Card A = American Express M = Master Card
5 = Leadership D = Discover V = Visa

Recommender Selecting Recruiting Rewards

Representative - District Acct # Branch A = Atl Recruit Reward for Recommender Alternate Reward #
M = Mgr 1 = Alternate Reward 7 = Leadership Bonus
N = Nwk 2 = Check 6 = N/A 8 = Presidents Points
P = Pas
Recommender - Name Street City State Zip

eLiterature Signature Obtained? Print Materials Publicity Release? Preferred Preview? mark. Appointment? Group Code County Code
E = English
Yes S = Spanish Yes Yes

3 Way Link/First Generation Assignment? District Acct # Branch A = Atl Leadership Representative Name
M = Mgr
Yes N = Nwk
P = Pas
Co-Applicant? Title Mrs (1) First Name MI Last Name Birth Date Social Security or Tax ID #
Ms (2)
Yes Miss (3)
Mr (4)

Co-Applicant Signature Obtained? Yes