Professional Hair Goods Order Form

9319 Barrington Lane, Port Richey, Fla. 34668
Phone: 813-863-5788

Print this form. Fill it out and mail or fax it.

Items Ordered
Quant Style Name             Color Code  Price   Total
    
     
     
    
 Subtotal Wigs: US$ 

FACE UP
Quant  Size                   Price     Total
    US$25ea	 


 Subtotal All: US$  

Shipping & Handling in the U.S. (only)
For 1 to 4 pieces, add US$6. Each additional piece, add US$1.00
Outside the U.S., please call for a shipping estimate
Shipping & Handling: 

   Total Price: US$    

Name: ________________________________________________
              
Address: ______________________________________________
              
City: ___________________________  State: ______  Zip: _________

Payment Enclosed:        ___ M.O.            ___ Check
              
Credit Card Payment:     ___ M/C             ___ VISA
              
Card# ____________________________ Exp. Date: ____--_____
              
Signature: _______________________________________________

© 1998 by Professional Hair Goods & 3D Comm.