Legal Name *

The name on your legal documents.

First Name

Last Name

Phone *

(###)

###

####

When did you receive this tattoo? *

Answer this question even if Ilia was not your original artist.

MM

DD

YYYY

Which service are you requesting? *

Cover Up

Blast Over

Rework

Black & Grey or Color? *

Black & Grey

Color

Tattoo Budget *

You can click one or more, but you must ALWAYS click a number value when you click "Sliding Scale", because I need this context. The Minimum is always $200.

$200-$300

$350-$450

$500-$600

$650-$750

$800-$900

$950-$1000

$1000+

Sliding Scale

Preferred Date *

My days of operation are Wednesday - Saturday.

MM

DD

YYYY

Preferred Time *

My hours of operation are: Wed-Fri: 3pm-9pm. Sat: 12pm-6pm

Hour

Minute

Second

AM PM

2nd Preferred Date *

My days of operation are Wednesday - Saturday.

MM

DD

YYYY

2nd Preferred Time *

My hours of operation are: Wed-Fri: 3pm-9pm. Sat: 12pm-6pm

Hour

Minute

Second

AM PM

3rd Preferred Date *

My days of operation are Wednesday - Saturday.

MM

DD

YYYY

3rd Preferred Time *

My hours of operation are: Wed-Fri: 3pm-9pm. Sat: 12pm-6pm

Hour

Minute

Second

AM PM

Service Agreement *

I have read and agree to all the terms and conditions presented in Ilia's Service Agreement.