Appointment Request Form
Availability and Booking Info
I am available Monday, Friday, Saturday, Sunday. Please wait 24-72 hours for me to get back to you after submitting your request form. I will respond via email from burningrebelliontattoo@gmail.com. Deposit must be paid to confirm booking. Consent form must be filled out day of appointment prior to service. Shop minimum is $150.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Description of tattoo(s)
*
Please include the style and complete details of the tattoo you have in mind.
Approximate size of tattoo(s)
*
Size in inches or a comparison to something common
Placement of tattoo(s)
*
Example: hip, spine, forearm
Do you have tattoo(s) you want covered up?
*
Yes or No
Reference Photo
*
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Reference Photo
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Reference Photo
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Reference Photo
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Please include a photo of the area of your body you would like tattooed.
Especially if you have other tattoos or you are wanting something covered up.
Reference Photo
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Instagram Handle
How did you hear about me?
Do you need a price quote?
*
Shop minimum is $150
Which month would you prefer to be booked?
*
Which days work best for you?
*
I work Monday, Friday, Saturday, Sunday
Submit
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