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Dixieland Boutique Ambassador Application
Thank you for your interest! Please complete this form, and we will review it, Please allow 3-5 business days for a response. We can also be reached at
DixielandBoutique@gmail.com
if you have any questions.
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Name
*
First and last name
Your answer
Why would you be a successful ambassador for Dixieland Boutique?
*
Your answer
Email
*
Your answer
Phone number
*
Your answer
Please list your social media handles (Facebook, Instagram, Tiktok, Pinterest, Youtube, etc.):
*
Your answer
Are you currently a rep/ambassador/influencer for any other brands or stores? If so, please list them:
Your answer
Have you been a rep/ambassador/influencer for any other brands or stores before? Please list them if so.
Your answer
Where did you hear about our Ambassador Program?
*
Facebook
Instagram
Tiktok
from a friend
Google
in the store
Required
What is your date of birth?
*
MM
/
DD
/
YYYY
Where do you live (city & state)?
*
Your answer
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