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First Name Middle Initial Last Name Address City State Zip Phone (area code first) Cell (area code first) Email Age Other than English, do you speak any other languages fluently?                                Yes No -if yes, please specify. Have you ever owned or operated a business?                                                              Yes No Independently owned or with a partner? Independent Partner Was this business a francise, licensee or independent? Francise Licensee Independent Was it a product or service based business? Product Service Both How long in operation?   Location of Business?   Home Based Commercial Location Gross yearly business revenue?       Do you still own that business now?   Yes No if no, please explain why. Estimated yearly Income?   $10K - $25K $25K - $50K $50K - $75K $75K - $100K $100K - plus Are you currently employed?   Yes No What is your current position? What is our everyday Job requirements? How long with this current/latest company? How long in this field of work? Why do you feel you are ready for a change? Estimated yearly Income?   $10K - $25K $25K - $50K $50K - $75K $75K - $100K $100K - plus Do you own a computer?   Yes No -if yes, please specify.   Desk Top Lap Top From 1 - 10, 10 being the best, how would you rate yourself in computer skills?    1 2 3 4 5 6 7 8 9 10 Do you have internet access from home?   Yes No Do you have a fax?   Yes No Though for99bucks.com is a web based business, it sometimes requires you to visit clients. Do you have reliable transportation should you be required to meet with them?           Yes No Though each Agent and area is different and varies greatly, how much income do you realistically want to make in the first year should we accept your application? What is the best time to reach you?   Mornings Afternoons Evenings Best number to reach you? (please enter phone number with area code first) This number is your...   Home Cell Work