FIRST NAME:
LAST NAME:
ADDRESS #1:
ADDRESS #2:
CITY:
STATE:
ZIP:
COUNTRY:
PLEASE SELECT THE SERVICES YOU ARE INTERESTED IN:
Hair Services
Nail Services
Spa Services
Hair & Nail Products
Diva Line
All
HOW OFTEN HAVE YOU VISTED DIVAS?:
NEVER
1-3 TIMES PER YEAR
4-6 TIMES PER YEAR
ONCE A WEEK
ONCE A MONTH
OTHER
HOW WOULD YOU LIKE TO HEAR OF OUR SPECIALS
(CHECK ALL THAT APPLY)
U.S. MAIL
E-MAIL
TELEPHONE
PLEASE SELECT THE LOCATION NEAREST YOU:
New Orleans,LA (Bullard)
New Orleans,LA (Canal)
New Orleans,LA (Westbank)
Metairie,LA
Slidell,LA
Alexandria,LA
Baton Rouge,LA
Lafayette,LA
Shreveport,LA
Jackson,Ms
Mobile,AL
Atlanta,GA
Houston,TX
COMMENTS?
