Name *

First Name

Last Name

Phone

(###)

###

####

Type of Jewelry *

Please select the type of piece you would like. You may select multiple.

necklace

bracelet

pin

ring

earrings

other (specify in description of piece)

Requested completion date (optional, see note below)

Please plan ahead! A custom piece can take 3-4 weeks to curate. I ask this to gain a better understanding of your timeline and will try my best to meet your request. I, however, CANNOT guarantee that you will get the piece at this exact date.

MM

DD

YYYY

Address *

Enter the address that you would like the piece sent to

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country