CHI Club Enrollment

Please check one:

New Member

*Existing Member

*If existing member, list Club CHI account #:

My salon is:

a retail location.

a home business location.

Send mail to:

salon

home/home business

Ship products to:

salon

home/home business

Salon Information:

Salon Name Address City State / Province / Region ZIP / Postal Code Country

Stylist/Salon License #:

Are you a certified Farouk educator?

Yes

No

Are you an active CHI artist with Farouk Systems?

Yes

No

Selection of this box indicates your RETAIL SALON exclusively carries Farouk products and no other manufacturer.

My salon is an exclusive CHI salon.

Distributor your salon purchases from:

Member Contact Information:

First Name Last Name

Address:

Street Address City State / Province / Region ZIP / Postal Code Country

Date of Birth:

Email:

Title:

Owner

Booth Renter

Cell Phone:

Salon Phone:

Home Phone:

Additional partner, if applicable:

First Name Last Name

Date of Birth:

Additional partner, if applicable:

First Last

Date of Birth:

Education