Virginia Independent Sales Representative Application

Fill out the form below and a member of the EZlocal team will contact you by phone within one business day. Or go back and select another location.

First Name

Last Name

Doing Busines As "DBA" (if any)

Business Street Address

City

State

Zip

Business Phone

Business Type

Corporation

Partnership

LLC

Sole Proprietorship

Website URL (if any)

Describe any professional training or certification you have have received in sales and/or online marketing:

Business expenses you pay now (if any)

Equipment you own and plan to use to sell our solutions (check all that apply)

Laptop/tablet (recommended)

Smartphone

Printer

Fax

Resume (doc, docx, pdf)

I (we) certify that the information contained in this application is correct to the best of my knowledge and understand that falsification of any information is grounds for refusal or severance of Independent Contractor status. I further understand that I (we) cannot represent myself as a representative of EZlocal until I have been approved by EZlocal. I (we) authorize and instruct any person or consumer reporting agency to make inquiries and compile such reports as may be requested by EZlocal and I (we) also authorize EZlocal to make whatever inquiries and investigations necessary in connection with this application. I am aware that pursuant to the Fair Credit Reporting Act, that I may make a written request within a reasonable time for disclosure of any information received from any consumer reporting agency as authorized herein.