Jewelry Repair and Custom Order Form

Jewelry Repair and Custom Order Form

Please fill out the details below to help us understand your jewelry repair or custom jewelry needs.
Customer Full Name

First NameLast Name
Customer Email Address
example@example.com
Shipping Address for Delivery

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Preferred Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Communication Preference
Metal Type
Description of repair project (please upload photos in the “upload images” section)
Description of custom jewelry Project. You can also upload sketches in the “upload images“ section or, if possible come up with 5 adjectives.
Description of re-purposed jewelry or stones (please upload a photo in the “upload images”section)
What is your budget? This helps me determine the materials and techniques so that I can build the jewelry around your budget.
Desired due date for completion (turnaround time is approximately one month for custom projects and 2 weeks for repairs)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Upload Images of Jewelry (Inspirational)

Cancelof
How did you find us?
Should be Empty: