Please print and complete this order form.
Hair By Mail
New System Order Form
Make checks payable to: New Look Hair Replacements
Mail your order to: 2114 N. Flamingo Rd, PMB #183, Pembroke Pines, FL 33028
Call Toll Free - 877-886-9045
Name___________________________________
Date_________________
Address_________________________________
City__________________________ State__________ Zip Code________ Country____________
Area Code and Phone Number (____)______________ E-Mail Address___________________________
Wearers Name or Initials_____________
Short Description of System sent to Duplicate ___________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Hair Type Desired: Human Hair___ Synthetic Fiber___
Style: Please indicate one:
Hair Parting Styles
Wave Or Curl Pattern: (examples) Body Wave___ Slight Wave___ Medium Wave___Tight Wave___ Medium Curl___ Tight Curl___
Finished Hair Density: Light___ Medium___ Heavy___ Other___________________
Finished Hair Length:_____ (Maximum finished length is 5" with no extra charge)
Match color to System Yes___ No___
Scotch Tape Large Hair Samples in appropriate boxes. (how to take hair samples)
Head Map
2
LEFT
TEMPLE
.
.
.
4
BEHIND
LEFT EAR
.
.
.
2
RIGHT
TEMPLE
.
.
.
 4
BEHIND
RIGHT EAR
.
.
.
1
FRONT
.
.
.
.
3, 5
TOP
.
.
.
.
6
BACK
.
.
.
.
Special Requests: ________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Quantity Ordered               _____    Additional charge for longer finished lengths.
Price of First System Ordered $249.99   Add $20.00 Ea. for 6" to 7" Finished Length
Second System $199.99         $_____    Add $30.00 Ea. for 8" to 10" Finished Length
Additional Charges            $_____    Add $50.00 Ea. for 11" to 12" Finished Length
Miscellaneous Supplies        $_____    Add $70.00 Ea. for 13" to 14" Finished Length
Total System Charge           $_____    Add $90.00 Ea. for 15" to 16" Finished Length
                                        Add $50.00 Ea. for 28 day rush delivery

Please include $13.40 for UPS-Ground shipping.  UPS 2 Day Air and Overnight shipping is additional.
Please make all checks and money orders payable to "New Look Hair Replacements"
Credit cards will be charged when the order is shipped.----------------------------------------------------------------------------- To Pay By Credit Card - Visa____  MasterCard____  Amex____  Discover____  Call Me____ Exact Name on Card__________________________ Number____________________________  Expiration _______ Verification Code _____ Signature_________________________    Date__________________