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Please call the salon, or fill out the form below to request an appointment.  We will make every effort to try and work with your requested appointment time and date.  We will notify you of your appointment time and date via email and a phone call.   

Name:       
Address: 
City:   State:   Zip:
Phone:   Alternate Phone:  
Email:

Preferred Stylist:
Type Of Appointment:   
Other Information:   
Date Requested: 
Time Requested: AM:  PM:

Myra J A Salon • 1133 East Second St. • Defiance, Ohio 43512 • 419-782-7177 • myrajasalon@yahoo.com                         Web Design by: Natural Design & Graphics