Free Sample Order Form for Professionals

FREE Samples - and Catalogs Order Form
For Professionals in the beauty business United States Only

If you are not a licensed stylist or a salon/school owner please click below to go to "regular people" form.
In the USA .... OUTSIDE the USA

Please fill in all information
Job Description (select one)	Hair Stylist or Salon Owner Cosmetology School Owner or Cosmetology Instructor Cosmetology Student Other (describe below)
If you are not already in our computer, how can we verify your professional Status?	I am in your computer already. Call Salon/School I'll send you a copy of my license. Note >>> After you hit the select button at the bottom of this page, you will see the information you need to mail or fax your license to us.
Salon Phone #>
Alternate Phone #>
Doing Extensions >	Yes - or - Not Yet
If Yes - Methods>
Salon Name >

Email
First Name
Last Name
Send to >	My ... Home Work ... Address Below
Address
City
State
Zip Code

Optional Information ... Because I want to better understand more about our friends and customers, it will help me if you complete the information below. Thank you! ... Charlotte
When I write to you or Email you, how should I address you? Examples: >> by your first name or >> more formally [Ms., Mrs., Mr., etc.] or >> by a nickname Hello ... (fill in)
I am a ... Female Male
My age is ...
Where did you hear about us? A mailing I received Searching the Internet Other Describe >

We welcome your comments, questions and suggestions!

	Click on the Submit Button — and you have ordered your FREE Catalogs and Samples.
	WARNING: If you click here ALL the information, including your name, address, etc. will be deleted. If you simply want to change a few items you checked, go back up to the area where you want to make the changes and just change that information instead of starting all over.

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GARLAND DRAKE INTERNATIONAL
1001 West 17th Street, Suite S
Costa Mesa, California 92627-4512 USA
Email to Charlotte@GarlandDrake.com
Email to Raymond@GarlandDrake.com
www.GarlandDrake.com

Telephone: 1·800·426·9197 - or - 1·949·722·2277
Fax: 1·888·801·8530 - or - 1·949·722·2270
In Office Hours
Weekdays 8:00 AM to 4:00 PM (Pacific Time)

Since 1990