Wholesale Application and Sample Video Order Form



The Magic Of Wigs

 Mail order to: 

Hair Again Order
1370 Trancas Street, Ste 187
Napa, CA 94558

Note:  All Fields are required.  

 Wholesale Application Section

Your Name

 First:   Last: 

Your Title:

Your Email

  

Your Phone:

Type of License

Business    Cosmetology    Hairdresser    Reseller

License Number:

  

Issue Date

Issued By:

Company Information Section -- Please Complete:

Company Name:

Street Address:

City:

State:

        ZipCode:  

Country:

  

Phone:

Fax:

Confirm your video order: 
  I understand the video is $14.95 plus $8 U.S. shipping & handling, ($22.95), and if I order 12 or more videos later, I will receive one additional video at no cost to make this sample "free".  I also understand that I can return the video within 10 days of receipt and receive a refund of the purchase price (less shipping and handling).
Shipping Information:
   Ship to above name and address.
  Ship to a different address:

Recipient name::

Address:

City

State

Zip Code:

Country:

Please enclose a cashiers check or money order made payable to "Wizard Marketing" for $22.95