| Quantity: | |
| Head 1 (Name): | |
| Head 1 #(and hair color): | |
| Head 2 (Name): | |
| Head 2 # (and hair color): | |
| Head 3 (Name): | |
| Head 3 #(and hair color): | |
| Head 4 (Name): | |
| Head 4 #(and hair color): | |
| Add a 5th Head?: | |
| Head 5 (Name): | |
| Head 5 #(and hair color): | |
| Family Name (ex The Smiths or The Smith Family) : | |
| Address (Street): | |
| City: | |
| State: | |
| Zip Code: | |
| Phone Number: | |
| Does any Heads need special features? (hat,moutache, beard, glasses,sunglasses, african american skin tone, asian eyes, goatee, bow, earrings, bandana, 1/2 goatee, 1/2 glasses): | |
| Any Comments?: | |
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