Broken China Jewelry and Cameo Jewelry



Custom Order Form

DINNERWEAR JEWELRY CUSTOM ORDER FORM
Name:__________________________________________________________________
Address: _______________________________________________________________
City, State, ZIP Code: ____________________________________________________
Phone Number: __________________  Email Address: _________________________
Feel free to call or text Mary-Ann with any questions:  508-641-9078
______  Small heart pendant necklace ($78)
______  Large heart pendant ($159)
______  Oval or round pendant necklace ($88)
______  Round pendant necklace with flower bail ($120)
______  Teardrop pendant necklace ($99)
______  Rectangular pendant necklace ($105)
______  Double pendant necklace with crystal or pearl drop ($150)
______  Large circle floral filigree pendant ($159)
______  Tassel pendant necklace, circle or oval ($110)
______  Dangle earrings, circle oval or rectangle ($120)
______  Dangle earrings, 14k gold ($259)
______  Stud earrings ($78)
______  Circle Hoop earrings ($105)
______  Round cufflinks ($170)
______  Three charm dainty bracelet ($130)
______  Single charm dainty bracelet ($88)
______  Adjustable bolo bracelet, round or oval size s/m or m/l ($58)
______  Circle cuff bracelet ($95)
______  Oval cuff bracelet ($105)
______  Expandable bangle bracelet, size s/m or m/l ($88)
______  Adjustable round ring ($58)
All necklaces come with a 16” chain. You may upgrade to 18”, 20” or 24”. All custom order jewelry is sterling silver. There is an up-charge of $20 per piece of jewelry made from a teacup or curved china.
How many pieces are you sending with this order? Please describe them :____________________________________________________________________
Special Requests: ________________________________________________________________________
I will make my best effort to create beautiful jewelry for you. In the event of unexpected breakage, loss or any other damage, our liability is limited to the replacement value of the pieces you have entrusted to us. 
MAILING INSTRUCTIONS:
1. Using tape, please indicate with circles the parts of your china you’d like us to cut. You can also ask us to suggest areas.
2. Pack your china in a sturdy shipping box, using plenty of padding.
3. Please sign here to show that you have read the terms and agree to them. Include the signed form in the box with your china.
Signature: _____________________________________  Date: __________________________
Ship this form with your china to:
               Mary-Ann Wood      1237 Pond Street    Franklin, MA 02038 
I’ll contact you when your china arrives so we can begin designing.
I look forward to talking with you and seeing what you have!