ORDER FORM

ORDERED BY:

Name *

Address *

City, Zip

Contact Number

Email

SHIPPED TO:

Name *

Address

City, Zip

Contact Number

Jewelry Type
NecklacesEarringsBracelets (Depending on jewelry type additional measurements may be required).Other (Please Specify)

Jewelry Name

Jewelry Price

I would like to have my jewelry in hand no later than:

For Custom Orders Only

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WomenMenUnisex

Allergic Reactions
YesNo

List Allergic Reactions

Jewelry Type

Requested Length (For comfort purposes, Bracelets, Necklaces/Neck wraps will be extended 1 to1.5 inches longer than the requested length)

Name/Description

I would like to have my jewelry in hand no later than