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Customer Authorization Form

This form must be completed after purchasing wigs or any products from Hair by Lia Simone. Failure to complete this form will result in order cancellations.

Order Number

First Name

Email

Last Name

Phone

By proceeding and submitting an order you acknowledge that there are no refunds exchanges or returns.You also agree not to file a dispute or charge back for your purchase *

I have read the product description and I understand what I am purchasing *

I am confirming that all credit/debit card information are valid and do belong the individual who is purchasing products and filling out this form*

ID Verification (Please provide ID verifying all information belonging to the buyer.)

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Your Signature

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