New Customer Registration Form

Wig Authorization Form
This form is used to confirm that you personally authorize the purchase and agree to the transaction. It also helps protect both the customer and our business from fraudulent or unauthorized orders. Orders will not be processed until the authorization form has been completed and submitted as final confirmation.
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
I Full name* authorized the amount of Exact order amount* to The Hair Gram.
Signature
Date

MonthDayYear
Date
UPLOAD A PICTURE ID (YOUR ID AND ORDER NAME MUST MATCH)

Cancelof
Should be Empty:

Wig Authorization Form