Ms Lola, LLC Custom Order Form
*Required Fields
Basic Price: $125
*First and Last Name:
*Shipping Address:
*Email Address:
* Phone Number:
*Head Measurements:
(Enter the correct measurements
for the Wig Type you are ordering.
*Freestyle Wig
*Hair Unit Type
Cut & Style (+$100)
(Enter any style from our Celebrity & Vanity
Hair Styles Gallery. You may also submit your
own style to medical_billing @MsLola.com).
*Hair Origin
*Hair Length
Hair Texture
*Main Hair Color
Light Colors &
Highlights(+$25)
Bold Highlight Color(s) that will be mixed
with the main hair color. To select more than one
color, hold down Ctrl on your keyboard while making
selections. (3 colors max)
Bold Highlight Mix Percentage
Soft Highlight Mix Percentage
Use highlight chart below to
indicate where you want soft and
bold highlights. Enter this
information into the COMMENTS
BOX. (Example: Area 1,3= 27
Area 2= 613)
Soft Highlight Color(s) that will be mixed
with the main hair color. To select more than
one color, hold down Ctrl on your keyboard while
making selections. (3 colors max)
2-Tone Hair Color
2-Tone Hair Color: Roots are the same
color as the main color. The rest of the
hair strand  is a different color, as shown
to the right. For more than one color, hold
down Ctrl on your keyboard while making
your selections.
*Resilient Swiss lace color
*Hair Density
2 Payments
Payment Method
Production Time
*Baby Hair
 20-Minute Phone Consultation With Ms Lola?
*Bleached Knots
 Insurance Claim?
*Cap Design
Shipping Preference: Cost is
based on your geographical
location and delivery time.
COMMENT BOX
Ms Lola will make your medical wig with the finest human hair and expert workmanship available. For the actual design of the unit, she will need your
choices, or specifications input into each pertinent field on the Custom Order Form.

The most important specification is accurate head measurements. Ideally, your wig fit your head like a glove for a natural feel and appearance.
Adhesives are designed simply to bond the lace to the entire your entire hairline perimeter.

It is important to make informed choices for each specification of your unit to insure that you will be happy with the results. Before you submit the
custom order form below, click on the links to learn more about Specifications and how to apply them to the design and production of your custom
unit.
Density                         Lace Colors
For your convenience, the Custom Order Form for full wigs and hair units are contained within the same order form below. Please input the appropriate
specifications for the hair unit that you want to order. If we have questions or concerns about your order, we will contact you via email. You may also call
us at 252-337-9844 if you have questions or concerns before production begins on your unit.
IMPORTANT: Changes can not be made after production begins.
Before submitting this order form, please read our Refund and Return Policies for custom wigs and hair units because these policies are binding without
exception.

If you need additional assistance with filling out the custom order form, please see our FYI page for answers to frequently asked questions, or you may
call our office at 252-337-9844, Tues - Fri, 10am -3pm EST. You may also schedule a 20-minute phone consultation with Ms Lola. She will be happy to
assist you with filling out the order form and answer any questions you have about our products and services.
Ms Lola LLC,
A Professional Hair Replacement Specialist for Almost 30 Years
Custom Wig/Hair Unit Order Form