(if different from Ship To)

Comments or Special Instructions:

Payment:

Contact Information: (if different)

Head Measurment:_________

PonyMode

Scarfabulous

PonySport

Underhair

Choose Shipping:

Choose Product: ( all $289)

Ship To:

Wear Your Own Hair

International Shipping:

Within the U. S.

Measure around the fullest part of your head with
a tape measure.

Send To:  Hip Hats With Hair   108 West Adalee St.   Tampa, FL 33603                     phone: 1-877-447-4287

(Please print out this form and fill in. Send in form with your hair)

Name____________________________________
Phone____________________________________
email_____________________________________

Name____________________________________
Address__________________________________ 
Line 2____________________________________
City______________________________________
State/Province______________________
Postal Code _______________________
Phone____________________________________
email_____________________________________

Cardholder name____________________________
Billing Address______________________________
__________________________________________

Card Number______________________________
Exp: ______ 

___Black Headband      ___White Headband

___Add Bangs ( + $16 )

___Tan
___White

___Blue Madras
___White Paisley

___Black
___Blue
___Pink

___Priority International Mail....$21
___GXG Global Express Guaranteed
      ( we will notify you of rates for GXG)

___UPS Ground....$11
___UPS 2nd Day Air....$21
___UPS Next Day Air ....$42

___Black
___Turquoise
___Pink Print

___Please call me for my credit card
___Check Enclosed
___Bill to: _________________________________