PMG Protective Layer Service – Acknowledgment & Authorization

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Confirm Shipping Address (for return shipment)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Select Your Service -This service applies a protective layer to the inside of grillz you already own. No design changes are included.

Please read and acknowledge:

I understand that all grillz are inspected before service. I understand that grillz that are poorly fitting, damaged, improperly made, or unsuitable may be declined. If my grillz are declined, I understand that the item may be returned without service and that inspection, shipping, and service fees are non-refundable.

Please read and acknowledge:

I understand that the protective layer is designed to create a barrier between metal and teeth, but that individual wear, fit, and usage may vary. I understand that EASE does not provide medical or dental advice and makes no guarantees regarding outcomes.

$100 Authorization Hold

Temporary $100 authorization hold - You will not be charged

I authorize EASE to place a temporary $100 authorization hold on my payment method on file.

$100.00 Quantity

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

I authorize EASE to place a temporary $100 authorization hold on my payment method on file. I understand that this authorization may be captured only in the event of a chargeback, payment dispute, or payment reversal initiated after the service has been completed

I understand that initiating a chargeback does not replace EASE’s resolution process and may result in additional charges if funds are reversed after services are rendered.

I confirm that I have read, understood, and agreed to all terms above. I acknowledge that this is a service-based transaction, not a custom product purchase, and that all sales are final once the service is completed.

Autograph Please :)

By submitting this form and completing payment, you agree to the PMG Protective Layer Service Terms and Authorization.

PMG Protective Layer Service – Acknowledgment & Authorization

$100 Authorization Hold*

$100 Authorization Hold