Your Name_____________________________________________ Date__________________

Street Address_________________________________________________________________

City ________________State/Province/Country__________Zip Code_____________________

Telephone (____)_________________ E-Mail________________________________________


Accessory, Price per Unit, Quantity ordered:_________________________________________

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Method of Payment: Use PayPal if possible. When Paying by check, Please make checks and bank money orders payable to American Hair Concepts. Do Not Send Cash or Stamps. No COD accepted. Personal checks must clear before shipping.

Postage USD $5.70 minimum USA delivery.
Michigan residents add 6% Sales Tax. Total enclosed........................$US________________

Mail Order Form to:
Troy Marketing
4351 Cherrywood Street
Troy, MI 48098-4280
E-Mail: tomrogers@wideopenwest.com