Name *

First Name

Last Name

Phone #

(###)

###

####

I am at least 18 years of age *

(*I will only tattoo minors with parental consent on a case-by-case basis in Springfield. I cannot tattoo minors in Independence/KC because of the city ordinance laws.)

Yes

No*

Approximate Size *

Small, 1-3"

Medium, 4-6"

Large, 7-12"

X-Large, 12+"