Jewelry Repair or Modify Contract
Client Contact Information
(client fills out this part)
Date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Text okay?
*
Yes
No
Email
*
example@example.com
Was this piece purchased from Mom's Custom Tattoo and Body Piercing?
*
Yes
No
This repair is for a piece you already own. If you are unhappy with the repair or modification, we can not return the piece or give any kind of refund, store credit, or exchange. The only exception to this will be if recommended by the manufacturer due to their repair limitations.
I understand.
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Jewelry Details
Counter Staff or Manger fills this part out
Manufacturer
*
Style/Name
*
Color/Gem
*
Gauge/Threading or Threadless
*
Material
*
Quantity
*
Who took in the Jewelry?
*
Repair Notes:
Modification Notes:
Submit
Should be Empty: