Concierge Mobile Salon Request

Mobile Service Request Form
Guest Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have a level, paved area at least 25 feet long for the mobile salon to park? Ex. Driveway or front of house in street?*

Type Yes, No or N/A in each field
Is your street wide enough for an RV to turn and park? *

Type Yes, No or N/A in each field
Are there any steep hills, narrow roads, or obstacles that may prevent access?*

Type Yes, No or N/A in each field
Would you be open to visiting our home-based salon if your location isn’t accessible?*

Type Yes, No or N/A in each Field
Requested Appointment Date
Acknowledgment
- I confirm that all information I entered in this form is accurate.
- I understand that for cancelation or rescheduling, I need to call the salon directly and talk to the staff to get voice confirmation.
- I confirm that the salon does not provide a refund for deposit payments.
- I released the salon for any liabilities or hold harmless for any damages, injury, or accidents that can happen during or after the procedure.
By signing below, you agreed that you have read and understood the terms and agreement above.
Date Signed

MonthDayYear
Date
Signature

Clear
Should be Empty:

Mobile Service Request Form