EmailMe Form - ECS Flex Pay Plan Hair and/or Service Request Form

Date Time *

MM / DD / YYYY

Name *

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Cell Phone *

### - ### - ####

Alternate Phone Number

### - ### - ####

How would you like us to contact you? *

Email

Phone

Text Message

Facebook Message

Please Check All that apply.

What time of day is best to contact you? *

Morning 8AM - 10PM

Afternoon 12PM - 3PM

Evening 5PM - 8PM

Anytime

Please Check all that apply.

Choosing your Hair Extension Installation Method

Please choose an installation method

What Install best suits your needs? All pricing is on a starting basis. Final pricing is set after Consultation *

CHOOSING YOUR HUMAN HAIR FOR YOUR EXTENSIONS

Please answer all of the following questions

What is your budgeted amount for the Hair Extensions Installation Service? *

$100 - $200

$200 - $300

$300 - $400

$500 and up

What is your budgeted amount for the purchase of your Human Hair? * *

$50 - $150

$150 - $350

$350 - $550

$550 - $750

$750 - $950

$950 - $1000 and up

Human Hair is a separate cost. Human Hair is NOT included in the Hair Extension Installation unless previously stated. Clients may Bring Your Own Hair (BYOH) to the installation appointment at their own risk.

What length extensions do you desire? *

For Multiple Lengths, please write each desired length. Be specific with color choice etc. *

Will you be bringing your own hair to your install appointment? * *

Yes

No

IF NO, PLEASE CHOOSE FROM OUR VIRGIN HAIR OPTIONS

If you are purchasing OUR Virgin Human hair, please select the HAIR ORIGIN you are interested in most. *

What texture are you most interested in? *

I will need a closure piece *

Yes

No

I am not sure, I need a consultation

A closure piece is for the client that wants none of their natural hair out

What color would you like your Hair Extensions to be? *

IF YOU ARE UNSURE OF WHAT COLOR(S) YOU WOULD LIKE , PLEASE SCHEDULE AN IN-PERSON EXTENSION CONSULTATION TO DETERMINE YOUR EXTENSION COLOR REQUEST

If you would like your extensions customed colored, please describe the look you desire here.

If you have a photo of the desired style that you would like please upload it here. This will help aid in accurate pricing. *

YOUR FLEX PAY PAYMENT PLAN

Which recurring payment frequency best suits your needs? *

Weekly

Bi-Weekly

Monthly

Custom Payment Schedule

How many Payments would you like to make on your Flex Pay Payment Plan? *

2 Payments

3 Payments

4 Payments

5 Payments

6 Payments

8 Payments (max # pmts)

The deadline date for all Flex Pay Payment Plans are 90 days from the initial start date. If by that date the balance has NOT been fulfilled, we will credit all monies you have paid toward a future service and/or product at our discretion.

Any other information You would like to share about your installation or yourself

FLEX PAY PAYMENT QUOTE

After completing this Flex Pay Hair & Service Request Form we will email you an Estimate with all your requirements within 24-48 hours.

Once you accept the Estimate, you will need to complete our Flex Pay Authorization Recurring Payment Form to start the Flex Pay Payment Plan.