Reshelling & Remoulding Order Builder | The Custom IEM Company

/// Reshelling & Remoulding: Build your Order
To order your reshell please fully complete the form below. Once submitted, what to do next including where to get your ear impressions made, ear impression instructions and where to send them to will be detailed for you.

Should you have any queries and or concerns please contact us.

Name:

Contact Number:

Email Address:

Your Address:

IEM Model:		Intended Use:

Faceplate Left:		Faceplate Right:

Faceplate Foils Left:		Faceplate Foils Right:

Shell Left:		Shell Right:

Canal Left:		Canal Right:

Shell Foils Left:		Shell Foils Right:

Cable Required:		Custom Artwork:

Recessed Sockets:		Rush Service:

Any message or notes about your reshell order:

* (all fields / questions should be completed)