Made To Order Questionnaire Your Name Address: Address line 2: City: State: Zip Code: Phone # Your Email 1) What type of jewelry do you want made? 2) Who is the recipient of the item? *Note* If this is for someone other than yourself, tell me a little about this person. How long have you known him/her? Are there any specific qualities about this person that you want to capture in the piece? 3) Is this piece for a special occasion? What is the significance of the event? 4) Please provide any other information you think may be useful in creating a custom piece for you or the recipient. Please allow up to two weeks upon submission of this questionnaire for me to respond with design proposals. Feel free to contact me via email regarding any questions or concerns. CHECK THE BOX to the right to agree to the stated timeframe. In order to submit this form you must successfully type the code above in the box below and make sure to check the box in the prior statement.