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:
Wave Or Curl Pattern: Body Wave___ Slight Wave___ Medium Wave___ Tight Wave___
Medium Curl___ Tight Curl___ (click here for examples of wave styles)
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___
Special Requests: ______________________________________________________
______________________________________________________________________
______________________________________________________________________
Scotch Tape Large Hair Samples in appropriate boxes below. (How to take hair samples)
 |
LEFT TEMPLE . . . |
BEHIND LEFT EAR . . . |
RIGHT TEMPLE . . . |
BEHIND RIGHT EAR . . . |
FRONT . . . . |
TOP . . . . |
BACK . . . . |
Price of First System Ordered: $275.00 - No charge for lengths up to 5"
Price of Each Additional System: $199.99 - No charge for lengths up to 5"
Quantity Ordered ________
$_______ System price total (first plus extras)
$_______ Additional charges for longer lengths $_______ Miscellaneous supplies (print form) $_______ Add $50.00 each for 28-day rush charges $_______ Shipping charges $_____ Total Charges |
$_______ Add $30.00 Ea. for 6" to 7" Finished Length $_______ Add $40.00 Ea. for 8" to 10" Finished Length $_______ Add $50.00 Ea. for 11" to 12" Finished Length $_______ Add $70.00 Ea. for 13" to 14" Finished Length $_______ Add $90.00 Ea. for 15" to 16" Finished Length $_______ Add $13.40 Ea. for UPS Ground shipping*. *Overnight shipping is additional - call for quote. |
---------------Credit cards will be charged when the order is shipped.------------------------
Credit Card Payment - Visa____ MasterCard____ Amex____ Discover____ Call Me____
Exact Name on Card_____________________________________________________________
Number______________________________ Expiration _________ Verification Code _______
Signature___________________________________________ Date______________________
