Custom Jewelry Request Form 
Please fill out this form if you are interested in having a custom piece of jewelry made for you, a friend, or family member!
  • Pieces will be ready for shipment, delivery, or pick up within a week of placing your order.
  • Pricing is based upon the type of gemstones used, the jewelry style, and the diameter of the piece.
  • Bracelets range from $30-$50
  • Necklaces range from $45-$125
  • Earrings range from $30-$50
  • Anklets range from $35-$50 
  • Each piece will come with care instructions, a 15% coupon, and a written love note describing the qualities and energetics of your unique piece of art.
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First & Last Name *
Email Address *
Phone Number *
Address to ship jewelry to
Jewelry Style
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Necklace Length (if requesting necklace)
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Bracelet Size (if purchasing bracelet)
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Anklet Size (if purchasing anklet) 
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Preferred Metal
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Colors (Please select all that apply)
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Specific gemstones that you would like to see included
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Design Description (please provide as much detail as possible, including specific design elements such as charms, patterns, accent pieces, pendants, etc. please reference any pieces that you'd like a similar style as ):
Budget
Please take a moment to include any other details or requests here. Thank you for your order!
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