Name: Street Address: City, State, Zip: E-mail address: Phone Number: Have you had work done at Chrome Gardens in the past? Yes No If yes, when was this work done? No Past Work Last 6 Months 6 Months-1 Year 1-3 Years 3-6 Years What Style or Type of Tattoo are you interested in getting? Full Color Black & Grey Tribal Japanese Portrait Other Where on your body do you want to put your Tattoo? Arm Leg Back Chest Other What size do you want your Tattoo to be?: Do you have reference material available? Yes No How can you send us this reference material?(Select one or more) E-Mail Attachment (gif or jpeg only please) URL Address (include URL Adddress in description) Fax Snail Mail When are you thinking of getting this tattoo? 4 Weeks 4-10 Weeks 3-6 Months 6 Months-1 Year With which Artist do you want to make an Appointment? Stacy Raye Bill Any Please describe what you want as completely as possible. When you have finished and submitted your request you will automatically be taken back to Chrome Gardens.