Custom Order Form

Name:_____________________________________ Order Date:_________________

Address: _______________________________________________________________

City: ______________________________________State: ______Zip: _____________

Email:_____________________________Phone:____________ Cell: _____________

Article:     necklace         earrings          bracelet          anklet        glasses holder
Material - Primary:       stone         pearl          shell          glass          wood
            Secondary:       stone         pearl          shell          glass          wood

Clasp:     lobster claw        spring-ring        toggle        hook        loop

Clasp Metal:          gold-filled over sterling             sterling silver
      gold plated over stainless steel.                        silver over stainless steel
      gold plated over brass.                                      silver plated over brass
      copper             brass            gun metal              antiqued

      Style:    strung       1/2 moon.      1/4 moon      with pendant.      knotted
                             lariat         beaded lace      pendant
      Length:     15      18.      21      24      40       other________

      Style: pin.    hinged-pin     sewn      hoop      loop      drop length: __________
      Ear-wire: fishhook      kidney      lever back.     stud      non-pierced


       Measurements: Wrist: ________________Bracelet: _________________
                               Ankle: _______________Anklet: ____________________

Glasses Holder: (Refer to color list in About our Products)
      Color - primary: ___________________ secondary ____________________

Additional Notes: