Breastmilk Jewelry Order Form
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Name *
Email *
Phone Number *
Address *
What kind of jewelry do you want? *
If you want a combination, which did you want?
If you want a ring, what is your ring size?
Which type of metal do you prefer? (Everything is Sterling Silver, and gold plated) *
What shape do you prefer? *
Do you want any inclusions in your jewelry? *
If you want inclusions, which of the following do you want included?
How do you plan on getting your milk to me? (I only require 10-30 ML) *
If you want to mail your milk, do you need a mailing kit?
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Do you want me to keep the rest of your preserved milk for any future jewelry pieces or repairs? *
Is this a gift? *
If this is a gift, please provide the name of the person this is being gifted to.
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