Order Change Form
Please fill out this form to request any changes to your existing order.Once your request is reviewed and approved, the applicable change fee will be charged to the original form of payment.This form does not guarantee that changes can be made. Any request submitted after production has started may be denied. Submitting multiple change requests for the same order may result in delays.
Full Name On Order
*
First Name
Last Name
Email Address Associated with Order
*
example@example.com
When was your order placed?
*
-
Month
-
Day
Year
Date
Where did you place your order?
*
Online
Pop-Up / Event
EASE HQ Hollywood
EASE Houston
Type of change requested
*
Design change
Material change (silver, gold, etc...)
Tooth number change
Add-on request
Other
Original item ordered
*
Please type what you ordered originally
Original teeth selected
*
Original material selected (silver, gold, etc...)
*
Please confirm the original order details exactly as placed.
Requested Change Details
*
Clearly describe the change you are requesting. Be as specific as possible. Vague requests may be denied.
Change Reason
Production Status Acknowledgment
*
I understand that if my order has already entered production, my change request may be denied.
Change Fee Acknowledgment
*
I understand that if my request is approved, a change fee will be charged to the form of payment entered on this form.
No Guarantee / Final Decision
*
I understand that submitting this form does not guarantee approval and that EASE has final discretion over all order changes.
Delay Disclaimer
*
I understand that approved changes may extend my production timeline.
Confirmation Statement
*
I confirm that all information provided is accurate and understand that incorrect or conflicting information may result in delays or denial of my request.
Charges are processed only after approval. Change fees are charged to the original form of payment, and any price difference will be invoiced separately.
*
prev
next
( X )
Change Fee
$50.00
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Please sign your name
*
Continue
Continue
Should be Empty: