Please print and complete this order form.
Hair By Mail
"Ready Made" Hair Replacement Order Form
50% deposit needed, No Exceptions
Mail your order to:
1366 NE 163rd Street Suite #200 - North Miami Beach, Florida 33162
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_____________
Model number ___________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
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Hair Type Desired: Human Hair___ Synthetic Fiber___
Match color to hair samples? Yes___ No___
Scotch Tape Large Hair Samples in appropriate boxes.
FRONT
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TEMPLE
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BACK
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Special Requests: ________________________________________________________________________
__________________________________________________________________________________________
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Quantity Ordered             
_____        


Price of First System        

_____


Price of Second System       

_____


Price of Third System        

_____


Miscellaneous Supplies       

_____ 


Total System Charge          

_____ 

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Please include

US$16.40 for UPS-Ground shipping. UPS 2nd Dair Air and Overnight shipping is additional.

Hair Replacements. Credit cards will be charged 50% at the time of the order

and the balance 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__________________