Fax/Mail Order Form
Billing Address
Shipping Information (if different than Billing Please
fax or email a legible copy of you government issued
photo ID (i.e. Driver's license, passport, state ID etc.)
To place your order, print fill out completely. Please fax to (248) 546-6004. Email to
donesiahair@lehosthair.com (no worries we have a SSL secure mode email system, or Mail to P.
O. Box 211151 Detroit, MI. 48221
Item Description
Quanity
Unit Price
Total Price
       
       
       
       
       
Sub Total
  
Sales Tax 6%
  
Shipping
Priority Mail
(US) $15
Overnight (US)
$40
International
Express mail
(outside the
US) $75
  
Total:
  
I hereby authorize Le'Host the Hair Group to charge my
credit card as payment for the above described
merchandise. Accepted payment methods are Master
Card, Visa, and Discover Card
Credit Card #
  
Exp Date (mm/yy)
  
Amount
  
Signature
  
Name:
  
Address:
  
   
City
  
Zip Code:
  
Phone:
  
Email:
  
Name:
  
Address:
  
   
City
  
Zip Code:
  
Phone:
  
Email:
  
Le' Host  The Hair Group
C/o Customer Service
PO. Box 211151
Detroit, MI 48221