First Name     Last Name  Street Address City         State         Zip  Phone #     Occupation  Email  How did you hear about us? Surfing the Net Hype Hair Magazine Soph. Black Hair Magazine Referred by Friend Referred by Family Member Hair Stylist Doctor Another Website Other Please Check the "NouriTress Perfect Hair" Products You Wish to Order:  Perfect Hair Vitamins ($34.95)            Perfect Hair Vitamins PLUS ($29.95)  NouriShaper Hair Spray ($15.99)     Follicle Therapy ($24.95)            Stimulating Shampoo ($9.95)             Stimulating Conditioner ($11.95)  Stop Shedding Protein ($11.95)        Leave-In Botanical Reconstructor ($11.95)  NouriShaper Hair Spray ($15.99)       Shea Butter Hair Moisturizer ($9.95)  VitaWrap Foaming Lotion ($11.95) PLEASE SELECT TYPE OF VITAMIN FOR KITS BELOW!!  NouriTress Hair Growth Kit [BEST BUY $80.00 & up] Perfect Hair Vitamins PLUS Peferct Hair Vitamins Regular - $85.00 Perfect Hair Vitamins PLUS for MEN  NouriTress Hair Growth Kit 2 ($70.00 & up)  Perfect Hair Vitamins PLUS Peferct Hair Vitamins Regular - $75.00 Perfect Hair Vitamins PLUS for MEN  NouriTress Hair Growth GIFT PACK [BEST BUY $95.00 & up] Perfect Hair Vitamins PLUS Peferct Hair Vitamins Regular - $100 Perfect Hair Vitamins PLUS for MEN  NouriTress Hair Growth GIFT PACK 2 ($75.00 & up) Perfect Hair Vitamins PLUS Peferct Hair Vitamins Regular - $80.00 Select Shipping & Handling Charge U.S. ONLY 1 Product - $7.50 2 Products - $9.00 3 Products - $11.00 4 Products - $12.50 Hair Growth Kit - $13.50 Hair Growth GIFT PACK - 13.50   INTERNATIONAL  1 Product - $11.50 2 Products - $12.50 3 Products - $14.00 4 Products - $16.50 Hair Growth Kit - $17.75 Hair Growth GIFT PACK - $17.75  (GA Residents add 7% Tax) Total Order including Taxes + Ship & Handling  Print this Form & Mail along with Check or Money Order to: NouriTress Hair Products, P.O. Box 491601, Atlanta, GA 30349 Remember, when paying by check, please allow two weeks for shipping!!!