Club CHI Rewards

Person sending this form:*
- Salon Owner/Stylist
- Sales Rep
- Distributor
Enter Your Name:*
Salon Name*
Business/Cosmetology License Number*
Salon Address (Please do not enter a P.O. Box)*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

*(Please do not enter a P.O. Box)
Salon Phone*
Membership Level*
- New Member
- Existing Member
Club CHI Account Number
My Salon is an Exclusive CHI Salon*
- Yes
- No
Selection of this box indicates your RETAIL SALON exclusively carries Farouk products and no other manufacturer.

My Salon Is In A*
- Retail Location
- Home Location
Please Send All Mail To*
- Salon
- Home/Home Business
Home/Home Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Ship All Products To*
- Salon
- Home/Home Business

Terms and Conditions*
- I have read and agree to the provisions of this Application and the Terms & Conditions.
By checking the box above, you (“you” or “your”) acknowledge your receipt and agreement to the Terms and Conditions set forth below, which govern the Club CHI Rewards Program (the "Program") offered by Farouk Systems, Inc. (“Company”).
Terms and Conditions applicable to the ClubCHI Rewards Program are set forth at the webpage www.farouk.com/club-chi-rewards-terms and are incorporated in their entirety into this Membership Agreement Application as if fully set forth herein. By signing below, you acknowledge your receipt and agreement to the provisions of this application and the Terms and Conditions.
Signature of Applicant*

Enter your full name as signature in the field above.
Do you want your salon address on the salon locator?*

Member Contact Information