Sparkle Therapy Custom Phone Case Request Form
Please complete all fields below so we can begin creating your custom piece with intention.
Customer Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Phone Brand
*
Please Select
Apple
Samsung
Other
Phone Model
*
Color 1
*
Please Select
Black
Gold
Silver
Turquoise
Pink
Purple
Green
Blue
Red
Color 2
*
Please Select
Black
Gold
Silver
Turquoise
Pink
Purple
Green
Blue
Red
Color 3
Please Select
No Thanks (3 Colors are enough!)
Black
Gold
Silver
Turquoise
Pink
Purple
Green
Blue
Red
Metallic Choice (Required — choose one)
*
Gold
Silver
Background Style
*
Clear Resin
Glitter Resin — we'll handpick the perfect glitter just for you ✨
Inspiration Image (Optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Additional Notes or Details
*
Submit Deposit
*
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CUSTOM PHONE CASE (DEPOSIT)
$14.99
$
14.99
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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