Custom Jewelry Order Form
Client Contact Information
Date
-
Month
-
Day
Year
Date
Full Name
*
First Name
Last Name
Phone Number
*
Text Okay?
*
Yes
No
E-mail
*
example@example.com
Would you like this Item shipped directly to you?
*
Yes, I will pay the shipping fee to have my custom order shipped to my house
No, I will pick up the jewelry in studio
Delivery Address - (please fill out only if you would like your item shipped)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Open to Jewelry Suggestions?
*
Yes
No
Back
Next
Jewelry Details
Manager or Counter Staff
Select one of the following
*
Please Select
Special Order
Custom Order
Group with Shop Order
Out of Stock Item
Jewelry Description or Name
*
Mechanism (threadless/threaded)
*
Gauge
*
Material
*
Gems/Colors
*
Setting
*
Length/Diameter
*
Quantity
*
Piercing Location
*
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Notes
Date
*
-
Month
-
Day
Year
Date
Counter Staff or Manager
*
Submit
Should be Empty: