(Print & mail with system)

Name ___________________________________
Date _________________
Address _________________________________
City __________________________ State__________ Zip Code________ Country________
Area Code and Phone Number (____)______________ E-Mail Address_______________________
Contact Name _________________________
Short Description of System sent to Duplicate _______________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Hair Type Desired: Synthetic:______________ % Human:______________ %
Style: Please indicate one: 

Wave /Curl Pattern: Body Wave___ Slight Wave___ Medium Wave___ Tight Wave___ Medium Curl___ Tight Curl___ Finished Hair Density: Light___ Medium___ Heavy___ Other___________________
Finished Hair Length:________ (Max. finished length is 7" 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: ________________________________________________________________________ _________________________________________________________________________________________ ________________________________________________________________________________________

Repair Cost is $150.00 + $10.00 shipping per unit: Longer lengths, Remy or Russian hair or replace lace front is additional cost -Total $________
Please check one below:
[ ] Visa [ ] Mastercard [ ] Amex [ ] Discover [ ] Check [ ] Money Order
(If CC order) Print Name___________________________________________
Account #: ___________________________________________
Expire Date: _____________________ CVV#: ______________
Card Holder Signature __________________________________
Prepayment is expected with order.  Delivery in aprox. 4-5 weeks. No refunds
Cindycut Inc. Ordering Dept.
1155 W. Pioneer Blvd.
Suite 103-133
Mesquite, NV  89027 USA