Custom Order Form

A customized piece of jewelry is a very personal gift and expression of thought that is best created through a process of discussion and review. Please feel free to contact me through this website, to begin this process and make arrangements to continue our discussion in a manner that is most comfortable for you.

Your Information

Your Name:

Your email address:*

Your telephone number:

Jewelry Design Information

Pet's Name:

Type of pet:

Pet's birth date:

Date of loss:

Would you like the jewelry personalized?No Yes

If yes, what information would you like included?

(pet's name, birth date, date of loss)

Please describe a specific memory, or information that you would like incorporated into the jewelry:

Do you have any physical items that you would like incorporated into the jewelry?No Yes

If yes, please describe these components:

What type of jewelry item would you like created?

Do you have any size, length, shape or color preferences, please list:

Do you have any time constraints, if so please list?

Please enter your price range (including shipping) for the item you are ordering:

Do you have any other comments or information for your order?

Gift Recipient Information

Is this piece of jewelry a gift for someone else?No Yes

If yes, the recipient's name:

Do you want us to contact the recipient about the order?No Yes

If yes, please include contact information:

Incluce email address, telephone number, or postal address

Do you want us to ship the order directly to the recipient?No Yes

If yes, the shipping address:

enter the numbers in the box to the left (required)