Broken China Jewelry and Cameo Jewelry

Custom Order Form


Your Name:__________________________________________________________

Address: ____________________________________________________________

Phone Number: __________________________     Circle best time to call: AM or PM

Email Address: _______________________________________________________

Feel free to call or text Mary-Ann with any questions:  508-641-9078

______  Small heart pendant necklace ($78)

______  Large heart pendant ($120)

______  Oval or round pendant necklace ($85)

______  Double pendant necklace with crystal or pearl drop ($140)

______  Large circle floral setting pendant ($120)

______  Tassel pendant necklace, circle or oval ($140)

______  Adjustable round ring ($58)

______  Adjustable square ring ($78)

______  Dangle earrings, circle or oval ($95)

______  Round cufflinks ($160)

______  Bracelet charm ($78)

______  Circle cuff bracelet ($95)

______  Oval cuff bracelet with rope detail ($199)

______  Expandable bangle bracelet, size s/m or m/l ($120)

______  Pin, sterling silver ($78)

______  Christmas Ornaments, heart ($68)

All necklaces come with a 16” chain. You may upgrade to 18”, 20” or 24”. All custom order jewelry is sterling silver. Add a crystal or pearl drop for $10. 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. 

1. Fill out the form.
2. 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.
3. Pack your china in a sturdy shipping box, using plenty of padding.
4. Include this form in the shipping box with your china.
5. Please sign here to show that you have read the terms and agree to them.

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 to go over your order with you.
I look forward to talking with you and seeing what you have!