Custom Order Form


Address: _______________________________________________________________________

City, State, ZIP Code: _________________________________________________________
Phone Number: __________________ Email Address: ____________________________
Join our monthly newsletter for special offers and custom order stories? YES or NO
What is the best time of day for us to call you? AM or PM
When do you hope to have this by? Date: __________________________________
All custom order jewelry is sterling silver.
There is an up-charge of $20 per piece of jewelry made from a teacup, curved or thick china.
How many pieces are you sending with this order? Please describe them: ____________________________________________________________________
Special Requests: ________________________________________________________________________
______  Check here to have leftover china pieces returned. Price calculated at time of shipping.
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. 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 
Feel free to call or text Mary-Ann with any questions:  508-641-9078
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!