Order Form

Name

First Name

Last Name

Phone

(###)

###

####

Email

Shipping Address

(if shipping)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Earplugs for what environment? Are you a vocalist?

(Open or closed jaw impressions?)

What type of earplugs? [$120/pair]

Add-ons:

Any color glitter [+20]

Connecting cord [+10]

Additional filter set [+25]

Keychain case [+$5] (connecting cords usually don't fit*)

If adding glitter, what color or colors? (scroll down for photo of options)

4 colors max. Please specify texture and if you want multiple colors to be mixed uniformly or swirled separately.

If adding an additional filter set(s), what decibel(s)?

Additional notes/questions?

Glitter options below. Click the photo to open a hi-res image in a new window or click here.