Hair By Mail - Hair System Repair Order Form

Hair By Mail
Order Form For Hair System (Repairs)
Make checks payable to - New Look Hair Replacements
Mail your order to: Hair By Mail, 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 __________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
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Hair Type Desired: Human Hair___ Synthetic Fiber___
Style: Please indicate one:

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)

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.
Major (like new) Repair $209.00 $______ Add $20.00 Ea. for 6" to 7" Finished Length
Minor (almost new) Repair $99.00 $______ 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 business rush
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.
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To Pay By Credit Card - Visa____ MasterCard____ Amex____ Discover____ Call Me ____
Exact Name on Card__________________________
Number____________________________ Expiration______ Verificaion Code ______
Signature_________________________ Date__________________