Custom Jewelry Design Order Form
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Name (Last, First) *
Email *
Phone # *
What kind of gemstone jewelry piece are you looking for? *
Please tell me about your favorite gemstones *
(Choose all that apply from the list below). I've listed only a few of my most commonly used stones, but please feel free to indicate any I missed under "other"
Is this item for a gift? If so, please tell me a little bit about the recipient. *
What is your budget for this order? *
This will help us determine what materials we should recommend for your piece.
When would you like to have the piece ready? *
Would you like this order shipped or do you want to pick it up? *
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This form was created inside of Modnitsa Atelier.