Jewelry Custom Order Form
If you have any questions please contact us at 914-941-0408
Sign in to Google to save your progress. Learn more
Full Name
Email Address
Phone Number
Shipping address
Billing address (put sas if its same as shipping)
Venmo, zelle, chase pay or pay pal username (if none of these are applicable please contact us at 917-941-0408)
Product *
Bracelet size (only applicable for bracelet)
Clear selection
Seed Bead Colors
Specialty Beads
Flat clay beads
Charms
letter/ number beads
Clear selection
Any specific information (pattern, design, number of charms, anything else to know)
custom writing
Thank you for your order!
we will send you an invoice shortly!
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Chappaqua Central School District.

Does this form look suspicious? Report