Order Form

Tricho Alopecia Solutions

 

Finest Hair Replacement & Hair Shop

Clients Name:
Adress:
Post code:
Phone:
Email:
System base type:
Attach photo?
Head Circumference in Inches:
Style below:
1Left Crown
Tricho Alopecia Solutions
2Right Crown
Tricho Alopecia Solutions
3Center Crown
Tricho Alopecia Solutions
4Left Part
Tricho Alopecia Solutions
5Right Part
Tricho Alopecia Solutions
6Center Part
Tricho Alopecia Solutions
7Pompadour Freestyle
All back / All front
Tricho Alopecia Solutions

Hair length:

Waves/Curls:

Straight: *
Slightly wave: *
Light wave: *
Afro: *
Tight afro: *

Hair density:

low: L; *
Medium: M; *
Medium Heavy: MD; *
Heavy: H; *
Frontal Hairline:
*
Temples:
*
Crown:
*
Back:
*

Hair length:

Type of hair:
*
Your Hair Ethnic Origin is:
*

Hair color:

Attach Sample?
Yes     No
Attach old hair system:
Yes     No
Highlights:
Baby hair in front:
Yes     No
Base color:
*
Any allergies?
Any allergies In special to polyurethane?
Special instructions:
Sign:
Date: