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Customers Info:
First Name:
Last Name:
Address:
City:
State/Zip:
Country:
Telephone #:
Email Address:
Regular Order/Rush Order:
Number of Orders:
Payment Amount:
Payment Method:
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Base Design:
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Base Material: (please circle)
TL 100 SUPER Fine Swiss
TL 150 Above Plus 3/4" Poly on Back/Sides
TL 200 French Lace
TL 250 Above Plus 3/4" Poly on Back/Sides
TL 300 I-Lace
TL 400 PSB - Artificial Skin
TL 500 3" SFS Front Plus
French Base
TL 550 Above Plus 3/4" Poly on Back/Sides
TL 600 Exercise Base
TL 700 New Generation
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Hair Length Desired:
(up to 6" included)
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Hair Style:
Left Crown:
Right Crown:
Left Part:
Right Part:
Center Part:
Left Break:
Right Break:
Flat Back/Comb Back:
Comb Forward for Pompadour:
Spikey Front:
Freestyle:
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Hair Density:
Section 1:
Section 2:
Section 3:
Section 4:
Section 5:
Section 6:
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Wave and Curl:
Straight:
Body Wave:
Slight Wave:
Medium Wave:
Tight Wave:
Medium Curl:
Tight Curl:
Other:
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Hair Color/Sample:
Please attach a swatch of hair to
match or send entire old unit for
color matching purposes.
Note: Please specify if you would
like old unit be returned to you.
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Add Highlites Color # _____ Sample
Section 1:____%
Section 2:____%
Section 3:____%
Section 4:____%
Section 5:____%
Section 6:____%
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ADD GRAY %
Human / Synthetic:
Section 1:_____%
Section 2:_____%
Section 3:_____%
Section 4:_____%
Section 5:_____%
Section 6:_____%
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Additional Instructions: |
All Payments Made Out To:
TopLace USA
PO BOX 7399
FARGO, ND, 58106,
USA
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TOPLACE USA