Good Hair Days, Inc.
73 Water St.
Leominster, MA 01453 USA


We accept AMERICAN EXPRESS, MASTERCARD AND VISA. Please type or print clearly. 
Do not Email this completed form. Please fax it to us.

NAME ON CARD__________________________________________

            __________________________________________

CARD NUMBER __________-___________ -_________-_________

EXPIRATION DATE  MM/YY _____/______

CVV2 SECURITY CODE ___________ (MC/VISA= 3 digits on the back/ AMEX= 4 digits on front)

BILLING ADDRESS_______________________________________
(IF SAME AS
 SHIP TO,      _______________________________________
WRITE SAME)
               _______________________________________

               _______________________________________ ZIP CODE___________

EMAIL ADDRESS  _______________________________________
(for questions and shipment notification)

COMMENTS _____________________________________________

______________________________________________________

______________________________________________________

We will keep this information secure and on file for convenient future reordering.

PLEASE FAX THIS FORM TO 978-537-9426*****International dialing 001-978-537-9426
***************DO NOT EMAIL THIS FORM*************