Onboarding Form – Vancouver Custom Ear Plugs

Internal Client Data Entry

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"*" indicates required fields

Contact Information

Name*

Date of Birth

Must be 16 years and older

Email*

Phone*

Shipping Information

Shipping Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Order

Please Select Your Product*

single of pair

Single ear only (not a pair)

Which Ear?*

Right Ear

Left Ear

Material for IEMs

Silicone

Acrylic

Add Detachable Neck Cord?

Yes, I want a detachable neck cord

Solid or Filtered?*

Solid (No filter)

Hocks Noise Braker® Filter

DR 5 Filter

DR 10 Filter

DR 15 Filter

DR 20 Filter

Our motorcycle earplugs do not come with a permanent neck cord option due to their shallow profile. (r)

Neck Cord?*

None

Permanent Neck Cord

Detachable Neck Cord

Convertible Neck Cord

Neck Cord?*

None

Permanent Neck Cord

Detachable Neck Cord

Convertible Neck Cord

rga

Acoustic Filter Strength*

ER 9 Music Filter

ER 15 Music Filter

ER 25 Music Filter

DM 10 Music Filter (mini)

DM 15 Music Filter (mini)

DM 25 Music Filter (mini)

DR 10 Filter (mini)

DR 20 Filter (mini)

Solid or Filtered?*

Solid (No filter)

Hocks Noise Braker® Filter

DIM 9 Impulse Filter

DIM 12 Impulse Filter

DIM 19 Impulse Filter

Solid or Filtered?*

Solid (No filter)

Hocks Noise Braker® Filter

DR 10 Filter

DR 20 Filter

DI 25 Industrial Filter

DIM 9 Impulse Filter

DIM 12 Impulse Filter

Solid (Class A) – Maximum noise reduction. Filtered – suppresses noise to a safe hearing level, while allowing important, normal conversation to be heard. Higher numbers block more sound. (pa)

Solid or Filtered?*

Solid (No filter)

Hocks Noise Braker® Filter

Solid (Class A) – Maximum noise reduction. Filtered – suppresses noise to a safe hearing level, while allowing important, normal conversation to be heard. Higher numbers block more sound. (pa1)

Solid or Filtered?*

Solid (No filter)

Hocks Noise Braker® Filter

Solid (Class A) – Maximum noise reduction. Filtered – suppresses noise to a safe hearing level, while allowing important, normal conversation to be heard. Higher numbers block more sound. (rga1)

Solid or Filtered?*

Solid (No filter)

Hocks Noise Braker® Filter

Solid (Class A) – Maximum noise reduction. Filtered – suppresses noise to a safe hearing level, while allowing important, normal conversation to be heard. Higher numbers block more sound. (pa1)

filter data

See filter data

Cable Options*

20″ Short Permanent Braided

58″ Long Permanent Braided

50″ Permanent w/In-Line Mic

Style*

Full-Shell

Full-Shell Low Profile

Half-Shell

Half-Shell Low Profile

Canal

Style*

Full-Shell

Full-Shell Low Profile

Half-Shell

Half-Shell Low Profile

Canal

Skeleton

*Please note that Triple Driver Earphones come in clear silicone only due to the placement of the drivers during manufacturing. A layer of colour can be added on the faceplate portion only for an additional fee, if requested.

Solid Colour or Swirl?*

Solid Colour

Make with 2-Colour Swirl

Colour*

Same colour for both

Different colours for left & right

Choose Colour*

Choose LEFT Colour*

Choose RIGHT Colour*

Choose Swirl Colour 1*

Choose Swirl Colour 2*

Option

✨ Add Glitter

⚡ Add Glow in the Dark

Choose Colour*

Black

Red

Blue

Clear

Choose LEFT Colour

Black

Red

Blue

Clear

Choose RIGHT Colour

Black

Red

Blue

Clear

Choose Colour*

Choose LEFT Colour*

Choose RIGHT Colour*

Choose Colour*

Choose LEFT Colour*

Choose RIGHT Colour*

Choose Colour*

Choose LEFT Colour*

Choose RIGHT Colour*

Choose Colour*

Red

Blue

Light Orange

Light Lime

Choose LEFT Colour*

Red

Blue

Light Orange

Light Lime

Choose RIGHT Colour*

Red

Blue

Light Orange

Light Lime

Choose Colour*

Red

Blue

Light Orange

Light Lime

abpro

Choose LEFT Colour*

Red

Blue

Light Orange

Light Lime

abpro

Choose RIGHT Colour*

Red

Blue

Light Orange

Light Lime

abpro

Choose Colour*

vcet

Choose LEFT Colour*

vcet

Choose RIGHT Colour*

vcet

Choose Colour*

Choose LEFT Colour*

Choose RIGHT Colour*

Choose Colour*

vcrm

Choose LEFT Colour*

vcrm

Choose RIGHT Colour*

vcrm

Choose Colour*

vcep1

Choose LEFT Colour*

vcep1

Choose RIGHT Colour*

vcep1

Choose Colour*

vcep2

Choose LEFT Colour*

vcep2

Choose RIGHT Colour*

vcep2

Choose Colour*

vcep3

Choose LEFT Colour*

vcep3

Choose RIGHT Colour*

vcep3

Choose Colour*

vcem1

Choose LEFT Colour*

vcem1

Choose RIGHT Colour*

vcem1

Choose Colour*

vcem2

Choose LEFT Colour*

vcem2

Choose RIGHT Colour*

vcem2

Choose Colour*

vcem3

Choose LEFT Colour*

vcem3

Choose RIGHT Colour*

vcem3

7-Day RUSH

Add 7-Day RUSH (Earplugs)

Add 7-Day RUSH (earphones)

7-Day Rush is manufacturing time only (business days). Does not include shipping time. However, we try our best to deliver RUSH orders within 7 days.

Any Special Requests?

Product Name