LB TATTOO DEPOSIT - Charlene Hsu
Please Read over carefully and complete the fields below.
Name
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First Name
Last Name
Pronouns
Phone Number
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-
Area Code
Phone Number
Email
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example@example.com
Artist
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Charlene Hsu
Deposit amount (unless otherwise discussed) *paid via Venmo
$150
Tattoo Description
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Please write in a brief description of your tattoo. Include subject matter, approximate size, placement, and any other pertinent details.
Appointment Date and Time (as discussed with artist)
I agree to leave a NON-REFUNDABLE and NON-TRANSFERABLE deposit for one or more tattoo appointments. The deposit will go toward the payment for my scheduled appointment(s). For multiple session tattoos, the deposit will be deducted from the cost of the final session. I must give the tattoo artist/shop more than 48 hours notice to reschedule my appointment, or i will forfeit my deposit. Any drawings left after 90 days without an appointment without an appointment made will also cause the forfeit of my deposit (at artist's discretion).
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initials
I must notify the artist / shop more than 2 days beforehand to reschedule an appointment, or I will forfeit my deposit.
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initials
I must notify the artist / shop only by calling the shop phone during business hours. I understand that an email, voicemail, or any other online messaging will not suffice as notice.
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initials
If I am late more than 15 minutes to my scheduled appointment, I forfeit my deposit.
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initials
I can only reschedule my appointment up to 2 times, or I forfeit my deposit. If I am getting a multiple session tattoo, I can only reschedule 2 of those sessions, or I forfeit my deposit.
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initials
Changing ideas for my tattoo from one design to a completely different design will cause the forfeit of my deposit.
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initials
I understand that if I am sick or have a rash, wound burn, skin irritation, or any other factor that might affect the area to be tattooed, I will not be able to get tattooed and must notify the artist / shop accordingly - prior to the appointment day.
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initials
I agree to a $180 minimum charge per session.
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initials
By signing below, I acknowledge that I have read and agree to the terms stated above.
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Today's Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Rows
Please check any of the
following conditions that apply
Covid-19 / Corona Virus
(or if I have been exposed)
Diabetes
Epilepsy
T.B.
Hepatitis
HIV / AIDS
Hemophilia
Scarring / Keloiding
Pregnant / Nursing
Heart Condition
Eczema / Psoriasis
Herpes
Cardiovasular Disease
Faint or DIzzy
Infections
Asthma
Blood Thinners
Please list any allergies, diseases, conditions, medications, or any known illnesses below. If none, please write "none".
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Upon completion of this form, I will pay my $150 deposit via Venmo to Charlene Hsu and send a screenshot of my completed payment.
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