1529 SE 47th Terrace 
Cape Coral, FL 33904 - USA
email: Please Click Here

Tel. USA .239.540.0085
Fax. USA.239.549.9797
USA Toll-Free 1.800.654.9884
Se Habla Español - 1.800.234.7967
UK Toll-Free. 0.800.098.8543

This Website is

For your privacy!

Order by mail or you can also visit us at in any of our own studios: (click on city name for map)
Cape Coral, FL: (239) 540-0085 Naples, FL: (239) 643-3300
Hollywood, FL: (954) 665-2457 Melville, NY (L.I.): (631) 271-3051
 

Men's Hair System Order Form

Tell us about yourself!

Please fill out this form completely. When finished, click the "Submit" button once at the bottom of the page to send it to us OR print the form out and mail or fax (+1-239-540-5945) it to us. Call or mail to contact information located at the top of this page.

This form is secured using an SSL Certificate.

Billing Information

First Name:
Last Name:
e-Mail Address:
Confirm e-Mail Address:
Telephone Number:
Fax Number:
Address:
City:
State:
Zip:
Country:
   
Shipping Information
Same as Billing Information
if not, please fill in the following information
First Name:
Last Name:
Telephone Number:
Fax Number:
Address:
City:
State:
Zip:
Country:
   
Hair System Model

For Men - I wish to order: (all systems are UNCUT!)
Add Cut & Style at bottom of list

Price


1 Diamond ("Miracle") Hair System only $169.00
2 Diamond ("Miracle") Hair Systems only $309.00

1 NEW Diamond-Afro ("Miracle") Hair System only $199.00
2 NEW Diamond-Afro ("Miracle") Hair Systems only $369.00

1 Skin Replica ("All-Skin") Hair System only $269.00
2 Skin Replica ("All-Skin") Hair Systems only $439.00

1 NEW Hybrid-Skin Breathable PU Hair System only $469.00
2 NEW Hybrid-Skin Breathable PU Hair Systems 2nd System FREE

1 Transbase ("All-Net") Hair System only $469.00
2 Transbase ("All-Net") Hair Systems 2nd System FREE

1 Bonding-Transbase ("All-Net") Hair System only $469.00
2 Bonding-Transbase ("All-Net") Hair Systems 2nd System FREE

1 Super Jewel/Lace Front ("Dream Lace") Hair System only $769.00
2 Super Jewel/Lace Front ("Dream Lace") Hair Systems 2nd System FREE

1 NEW Sensation Hair System only $469.00
2 NEW Sensation Hair Systems 2nd System FREE

1 NEW Sensation-Afro Hair System only $569.00
2 NEW Sensation-Afro Hair Systems 2nd System FREE

1 Transbase Men's Full Wig "Bodo" Hair System only $569.00
2 Transbase Men's Full Wig "Bodo" Hair Systems 2nd System FREE

1 Transbase Men's Full Wig "Bodo"/Lace Hair System
with Lace Front & Stretchable Base Material
only $869.00
2 Transbase Men's Full Wig "Bodo"/Lace Hair Systems
with Lace Front & Stretchable Base Material
2nd System FREE

1 Transbase Men's Full Wig "Bodo"/Lace-Afro
Hair System with Lace Front & Stretchable Base Material
only $869.00
2 Transbase Men's Full Wig "Bodo"/Lace-Afro
Hair Systems with Lace Front & Stretchable Base Material
2nd System FREE

1 NEW Hybrid-Skin Breathable PU Men's
Full Wig Hair System
only $869.00
2 NEW Hybrid-Skin Breathable PU Men's
Full Wig Hair Systems
2nd System FREE

1 NEW Hybrid-Afro Breathable PU Men's
Full Wig Hair System
only $869.00
2 NEW Hybrid-Afro Breathable PU Men's
Full Wig Hair Systems
2nd System FREE

1 Duplicate of my enclosed Men's Hair System starting at $199.00
2 Duplicates of my enclosed Men's Hair System starting at $359.00

Custom Made Hair System(s) add $50.00/system

  (Please give additional information below)  

 

DON'T FORGET CUT AND STYLE!

 
ADD CUT AND STYLE TO ONE HAIR SYSTEM only $30.00
ADD CUT AND STYLE TO TWO HAIR SYSTEMS only $60.00
DO NOT CUT & STYLE MY HAIR SYSTEM(S)  
  (Please do not forget to give additional styling information below)


General Information

  My age is (if you don't mind!)  

  I have worn a Hair System before Yes     No

 

Base Size

Please choose which method you will be sending us for base size:

I have a standard (stock) hair system size (please choose one)
Small (8"x6")     Medium (9"x7")     Large (10"x7.5")
**If base must be cut smaller than 10"x7.5" on Diamond or Skin Replica, there will be a $25 charge.**

Measurement from 3 fingers above the eyebrows to the beginning of the hairline on the back of my head is: inches (or cm ) see sketch (A)

Measurement of the bald area from side to side across the head is     inches (or cm) see sketch (B)

 
(For custom made system, if the base size is larger than 10"x7.5" (oversized base), there will be a $75.00/system charge)

I have enclosed my sized fitting cap for base size.  

I have enclosed an old Hair System for base size.  

I require a full cap wig and my head circumference is: inches (cm)

 

Hair Color

Please choose which method you will be sending us for color matching:
(Please choose only one selection)

My color number is (from HPH Color chart):

I have enclosed a taped sample of my own hair. Take samples from your own hair. Do not take from sideburns as they are usually more gray or lighter than the rest of the hair, and not from the lower neck as this is usually darker. Take a sample from behind the ear and tape it to the order form or put it in an envelope. Please make sure your hair sample is enough hair for us to determine a color. One stand is not enough!

I have enclosed an old Hair System for color matching.

 

Hair Type

Please choose which hair fiber you prefer: (click here for more info)

Synthetic Hair Fiber

Human Hair (If any gray, this percentage will be in Synthetic Fiber)
(so when having to recolor the human hair, the gray percentage will not change!)

100% Human Hair including gray percentage ($100 extra - custom only)

 

Hair Style

Please style my Hair System(s) like:

HPH Style Chart #:  

my enclosed photo or magazine clipping  

my enclosed old Hair System  

DO NOT Cut or Style my new Hair System(s)  

     

Waves/Curls

please choose the type that resembles your existing hair:

  Straight Slightly Wavy (20mm) Wavy (19mm)
  Curly (10mm)
 Afro (order our curl ring ($40 refundable)
or send a sample of your hair)
Afro Curl #:

     

Hair Direction

choose one of the types shown

Uneven Left Part Uneven Right Part Uneven Middle Part Left Part Right Part Middle Part Hair Forward Hair Backward

     

Hair Density

choose your desired hair density

  Very Thin Thin Thin/Medium (80% of our customers)
  Medium Full Extra Full (Addl. $20)

 

Hair Length

Standard hair length on most Hair Systems is 4" on top, 5" on sides and 6" in back. If you would like additional hair length, there is a charge of $20.00 per inch for any length over 6 inches. Extra length is custom made only (6-8 weeks).

Hair Length from back of the hair system:   inches (or cm)

Hair Length on sides of the hair system:   inches (or cm)

Total desired hair length, if longer than 6 inches: inches (cm)

Please use my enclosed old Hair System for hair length.


Additional Styling Instructions:

 

 
Payment  

Check - Payable to HPH Corp.

Credit Card

 
Visa
MasterCard
American Express
Discover
   
Card Number:  ---
3-4 Digit Security Code (CVV):  
Expiration Date:  
Cardholder Name:  

 

 

 


NEW!!!
Look Good! - Feel Good!
Introducing 2 new products from HPH Corp!
Amazing results!

New Collagen
Facial Masks
Only $2.99 (reg. $4.99)
Click here for more info


NEW!!!
Color-Off - hair color
stain remover.
Pleasant smell, fast working, all natural!

1 oz - $1.50
8 oz - $8.95

www.Color-Off.com

Please remember that any Hair System can be custom made to absolutely any specifications that you provide for us, we just have to know exactly what you want for us to make. We are the manufacturer, we do not outsource from other companies or go through distributors. We are the distributor, so please let us know with any questions or requests that you may have.

*Any estimate of lifetime expectancy is approximate. We cannot guarantee how long any hair system will last due to the care, maintenance, wear and tear of the hair system is solely dependent on the customer. We do make our systems to the highest quality possible using the best materials on the market. We recommended that every customer always have at least two hair systems, so that it is possible to "rotate" use and have a "spare" in case something does need to be repaired.

All images and text Copyright HPH Corp. ©2002-2015
All prices subject to change without notice.
Shipping charges are non-refundable.
All Prices are in US Dollars.
All prices listed on DiscountHairPiece.com are MAIL ORDER prices ONLY!
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