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City: State

I am interested in selling in the following territories (cities or counties):

Please enter a Phone Number or Email Address where you may be reached:

I understand that the position I am applying for is an independent contractor position; and if hired, the contract will clearly define that there is no employee/employer relationship between DEE and myself. Furthermore, I understand that, if I am hired to represent DEE, I will earn a commission based upon my sales, and DEE will issue me a 1099 at the end of each fiscal year.
Yes         No

I have reviewed the minimum requirements for being an Independent Contractor for DEE, and I agree that, if hired, I will fill all of these minimum requirements to represent DEE.
Yes         No

Do you have a valid US Driver's License? Yes         No

Have you ever been convicted of a felony? Yes         No
If Yes, please Explain:

Please write a brief cover letter in the space below explaining your employment history and interest in DEE:

Attach Resume (only .doc, .txt, .pdf, .jpg, .zip or .gif formats accepted):
or cut and paste below (Please Note: Resumes that are cut and pasted below will lose all formatting - font size, bold text, tabs, indents, returns, etc. Please attach resume above whenever possible):

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