Prime Tattoo Supply

Repair Request Form

Personal Info

First Name*

Last Name*

Email*

Phone Number*

Address 1*

Address 2

City*

State/Province*

Postcode*

Country*

Machine Info

Machine 1

Machine 1*

Serial 1*

Machine 1 Purchase Date*

Machine 2 (optional)

Machine 2

Serial 2

Machine 2 Purchase Date

Machine 3 (optional)

Machine 3

Serial 3

Machine 3 Purchase Date