Product Purchase Order Form

Wig Purchase Order

To Fufill all the needed requirements, I request this form to be filled out to its entirety. . By Signing you are stating that you FULLY UNDERSTAND all the terms and conditions stated.
Your Name

First NameLast Name
Your E-mail
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is this your first unit?
*If this is your first unit, I HIGHLY RECOMMEND a Closure Unit.
Is this wig needed for any medical scalp conditions (chemotherapy, alopecia, severe burn..) ? *
*If medically needed, Please inquire for other payment options

Required Wig Measurements*

Rows	Measurements in Inches
Circumference
Forehead to Nape
Ear to Ear Across the Hairline

Wig Purchase Order