Name *

First Name

Last Name

Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Does your piece require or have gemstones?

Yes

No

Do you have your own materials that will need to be used in the project?

Yes

No

Is there any of my past work that you would like me to replicated in this piece?

Yes

No

Would you like a mold of your ring made?

In case of loss, I can reproduce the exact design that you had me make. Cost is $150.

Yes

No

Please add me to your email list! *

We will not spam your email. We hate it too.

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No

I have read and understand the Ten Step Custom Jewelry Process and I approve of this process. *

Yes

No