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Top-Line Hairpieces - Order Form
Step 1 - Personal Information
Be sure to include ALL the information we need to ship to you.

Name and Address >>>
This is >>>
 Home Address Work Address
Email >>>
Daytime Phone >>>
Evening Phone >>>
Step 2 - Select Color for Top Line
Color Qty
Regular
Qty
Deluxe
JB - Jet Black
300.00
450.00
Stage 0 - Brownish Black
300.00
450.00
Stage 1 - Dark Brown
300.00
450.00
Stage 2 - Dark Auburn
300.00
450.00
Stage 3 - Auburn
300.00
450.00
Stage 6 - Strawberry
300.00
450.00
Cbr - Cool Brown
300.00
450.00
Stage 8 - Golden Blonde
300.00
450.00
Stage 9 - Blonde
300.00
450.00
Stage 10 - Lt. Yellow Blonde
300.00
450.00
Stage 11 - Pale Yellow Blonde
300.00
450.00
LB - Light Blonde
300.00
450.00
Step 4 - Shipping Choices
S&H - Continental USA S&H - AK, HI, PR
Priority Mail (1-3 days) - $11.00 Priority Mail (1-3 days) - $11.00
2-Day FedEx - $19.00 - Office
2-Day FedEx - $24.00 - Home		 2-Day FedEx - $20.00 - Office
2-Day FedEx - $25.00 - Home
1-Day - $34.00 - Office - Standard
1-Day - $44.00 - Office - by 10:30 am
1-Day - $54.00 - Office - by 8:30 am
1-Day - $44.00 - Home - Standard
1-Day - $48.00 - Home - by 10:30 am
1-Day - $58.00 - Home - by 8:30 am
 1-Day - $50.00 - Office
1-Day - $55.00 - Home
Saturday Delivery - $70.00 Saturday Delivery - $80.00
S&H - Canada/Mexico S&H - All Other Countries
Global Express (4-6 Days) - $25.00 Global Express (4-6 Days) - $35.00
S&H - Outside USA
Use my FedEx Account >>>
 Quote FedEx Shipping
Step 5 - Payment Options
Payment By (select one)
Credit Card - Information below.
Credit Card - You have my information on file.
Credit Card - I'll fax you my card information. (Below is our Fax #.)
Credit Card - I'll call you with my card information. (Below is our phone #.)
Money Order (US Funds/US Bank) - I'll mail it to you. (Below is our address.)
Check (US Funds/US Bank) - I'll mail it to you. (Below is our address.)
Credit Card Information
We accept American Express, Visa, MasterCard and Discover Card.
Number: Exp.: Date
Name on Card: Mine Different (complete information below)
Name, Address and Phone for Card Holder
I have the following questions or comments
and/or >> Type your Gift Certificate # here
Step 6 - Print out and ... Call or Email or Fax or Mail-In your order.
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Click - on the Submit Button — and you have ordered the Top Line Hairpiece.
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.
Garland Drake Website - All Sections
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
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