JealousyJane Couture Client Intake Form
First Name *
Last Name *
Email address *
How did you hear about JealousyJane *
Address *
city *
State *
Zip Code *
Phone Number *
Who referred you? *
Do you have a deadline or wedding date? *
What is your budget or price point? *
Birthday *
MM
/
DD
/
YYYY
What kind of Couture design are you interested in? *
Do you know specifically what you are looking in a couture fashion design, or do you prefer to designer to have freedom to create her artistic vision for you? *
Do you have any links to designs or images that may help illustrate your ideas to JealousyJane?
Any specific notes, questions or concerns?
Do you use facebook? If so what is your listed name?
Do you have a make up artist for you event? (we offer professional makeup and Hair services also)
Clear selection
Do you have a photographer for you event? (we offer professional photography services also)
Clear selection
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