CUSTOM JEWELRY REQUEST
AND ORDER
Person placing order
is--
Name_________________________________Email_____________________________
Day
phone_____________________________Evening phone_____________________
Mailing address___________________________________________________________
Design with the following person and
preferences in mind--
I want something for (circle all that
apply)
+Work
+Professional +Casual +Play
+Evening +Special occasion________________
Please design
+Necklace +Earrings +Bracelet +Other_______________________
I prefer:
+Silver
+Copper +Gold
+One strand +Two strands +Three
strands +Multi strand +Don’t know
+Delicate scale +Light weight +Medium
scale +Chunky/large scale
Regarding stones-- and color in general:
I
like___________________________________________________________________
_______________________________________________________________________
Exclude_________________________________________________________________
Length preferred
Necklace_____________________________With
pendant?_______________________
Bracelet_________________________________________________________________
Earrings_________________________________________________________________
Hair color and style_________________________________
Eye
color__________________________________________
Skin
tones_________________________________________
Extraordinary
features________________________________
Other
__________________________________________________________________
Payment due at time order is accepted and
finalized
All custom orders shipped within three
weeks unless otherwise agreed to
Order date_________________
Return with a color photo of intended
wearer
P. O. Box 543, Kirkland, WA 98083-0543