Uvelle Hair _ Salon Insider Membership Program

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	Email Address: Sales & New Product Updates The Box Office Collection

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	* denotes required field Company Name* First Name* Last Name* Billing Address* Company Name Street Address Floor / Suite # City State or Province Zip Code Country Is the Billing Address the Same as Mailing Address?* Mailing Address (ignore if same as Billing Address) Company Name Street Floor / Suite # City State or Province Zip Code Country Primary Contact Phone Number* Secondary Contact Phone Number Fax Number* Primariy Email* Secondary Email Cosmetology License Number* Tax ID Number (if applicable... needed for tax exemption) I will submit a clear copy of my Cosmetology License (with Business License if applicable) and Photo I.D. * By Email to sales@uvellehair.com By Fax to 646.448.8692 I agree to the Salon Insider Program Terms and Conditions stated in the Terms and Conditions Section of www.uvellehair.com* Please list hair extension methods used by your salon!* Method 1 Method 2 Method 3 Others Enter the code shown:

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