First Name

Surname

Email Address

Mobile Number

Have you worn hair extensions before? Have you worn hair extensions before? Yes No

Which brand are you interested? Which brand are you interested? Beauty Works Remi Cachet Balmain Zen I am not sure

Which Hair Extension Type? Which Hair Extension Type? Luxury Tape Tape Micro rings / Mini Tips Keratin Bonds Clip in Ponytails Topper I am not sure

Are you happy for us to keep your details on file for GPDR purposes? Are you happy for us to keep your details on file for GPDR purposes? Yes No

Do you have your own hair extensions? Do you have your own hair extensions? No Yes

Do you want a re-fit appointment? Do you want a re-fit appointment? Yes No

Are you interested in using Payl8r Finance to purchase hair extensions? Are you interested in using Payl8r Finance to purchase hair extensions? No Yes I dont know, I would like more information