Jewelry Repair Form

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Manufacturer *

Name Item/Description *

Gold color, diameter, gems, threading, etc

Damage

Broken pin, missing gem, etc

Backings *

If a pin has snapped in a backing, please note the length, gauge, and disc size of the backing for replacement

Additional Information/Estimated Wait Time

Jewelry Specialist Signature

PLEASE READ AND BE CERTAIN THAT YOU UNDERSTAND AND AGREE TO THE IMPLICATIONS OF SIGNING THIS DOCUMENT. PLEASE READ CAREFULLY AND THEN INITIAL NEXT TO EACH PROVISION TO SHOW THAT YOU UNDERSTAND AND AGREE TO WHAT IS WRITTEN.

Please initial in all of the spaces provided

By initialling you show that you have read and understand all of the provisions below

I understand that the manufacturer's warranty that this jewelry is covered by does not cover jewelry lost of damaged due to neglect or improper care. *

Please initial above

I understand that I will be responsible for any fees incurred to repair this jewelry that are not covered under the manufacturer's warranty. *

Please initial above

I understand that body jewelry is non returnable and non refundable. *

Please initial above

I understand that I will be responsible for picking up this jewelry once it has arrived and I have been contacted by someone from AVA Piercing Company. If I am unable to pick up my jewelry, I am responsible for notifying AVA Piercing Company that I need it to be shipped to me. *

Please initial above

If my jewelry needs to be mailed to me, I understand that I am responsible for providing an accurate mailing address and paying for shipping and handling fees including any additional insurance on the package. All jewelry shipped will default to $100 worth of insurance from the appropriate shipping company and if I wish to add any additional insurance then it is my responsibility to request it. *

Please initial above

I understand that AVA Piercing Company is not responsible for items lost or damaged in the mail. *

Please initial above

If there is any provision, section, subsection, clause, or phrase of this release that is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be reconstructed as though the unenforceable portion had never been contained in this document.

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.

Legal Name *

First

Last

What name would you like us to call you?

Email *

Today's Date *

Phone Number *

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.

Signature *

If you are under the age of 18, you will sign here and your parent/guardian will sign below. If you are over the age of 18, sign here. You will not need to sign in the second signature box.

Save and Resume Later

Let us handle this part!

PLEASE READ AND BE CERTAIN THAT YOU UNDERSTAND AND AGREE TO THE IMPLICATIONS OF SIGNING THIS DOCUMENT. PLEASE READ CAREFULLY AND THEN INITIAL NEXT TO EACH PROVISION TO SHOW THAT YOU UNDERSTAND AND AGREE TO WHAT IS WRITTEN.

Please initial in all of the spaces provided

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.

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