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Wigs, Hair Extensions & Hair replacement
(non surgical)
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contact from 10am to 7pm
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+91 98 67 68 55 65
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order form

 

www.allurehair.co.in

Ordering a wig, hair system is easy and 100% guaranteed or your money back! Here’s how it works...
 
First Name
Last Name
Address
City
Zip
State
Country
Email Address
Home Tel.
Bussiness Tel.
Mobile 1
Mobile 2
Fax
Date of Appointment
   
Gender
Male
Female
Which best describes you?
Currently wear a hair system
Do NOT wear a hair system
Tried Rogaine, Propecia or Transplants
Other
How old are you?
18-30
31-40
41-50
51-60
Older than 60
What is your ethnicity?
Caucasian
African American
Indian
Asian
Other
Additional hair length Indicate any additional hair length you desire.
Up to 6” (standard – no extra charge)
8” (add $30)
10” (add $45)
12” (add $60)
Hair type Indicate your preferences for the type of hair we should use in your new hair system.
Human Hair
Blend of Human & Synthetic
Synthetic Hair
Not sure
Hairstyle selection Hair styles are no longer shown in the Style Selector Guide.
I have indicated a hairstyle number from website.
I will include my own hairstyle photo.
I do not want my hair system cut-in.
Area of hair loss Check which of the hair loss patterns is closest to your own. It’s also very helpful if you’re able to attach a photo of yourself along with the kit.
I will include a photo of myself
Hair length, sides & back Check which length is closest to your own natural growing hair after a haircut.
14” (add $90)
16” (add $120)
18” (add $150)
20” (add $180)
22” (add $225)
Base construction Choosing the right base for your custom hair system is very important.
Duplicate base from my current hair system
I would like front callops
I will need a full cap system (Add $100)
Not sure
Measurements To ensure a perfect fit, we have several measures to determine the size, shape and contour of your balding pattern. Please complete as many of these options as you can.
I am enclosing a spare hair system that fits me well
I am including my own mold and/or the completed cast mold
I have used the enclosed Velcro strip to measure
my head circumference.
I have measured my present hair system
Method of attachment If you have a preference for how you like to attach your hair system, please indicate here. (We DO NOT automatically include attachment products with your hair system.)

Approximate wear time
I take off my system everyday
I wear my system for 1-2 weeks at a time
I wear my system for 3-4 weeks at a time
Unsure or other
Type of attachment
I use liquid adhesive (glue)
I use double-sided tape adhesive (tape)
I use a combination of both glue and tape
I use comb clips
Unsure or other
   
Method of Payment We require at least a 100% down payment before ordering, however, we WILL NOT order your hair system or charge your credit card until after first speaking with you to review this order form.
I prefer to pay by credit card (details provided below)
I prefer to pay by check (payment enclosed)