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Congratulations! You have decided to order the most unique gift you can give to your special person or yourself!

To complete the form you will need to have the following information ready:

1. The date or special number you would like represented.
2. The type of clasp you would like. ( View Clasps)
3. The bead you would like to have represent your date or number in the necklace. These are called Number Sequence Beads. ( view all bead options )
4. The bead(s) (up to two types) you would like to have used as spacers to separate the digits in your number/date.
These are called Spacer Beads. ( view all bead options)
5. The length you would like the necklace.


Directions
1. Please complete the following form. REQUIRED FIELDS ARE BOLDED
2. No payment is due now. Once we receive your order, we will contact you to finalize payment.
We currently accept payment by money order, cashier's check or Paypal.
3. Once your payment is finalized, you will receive your new necklace within 10 business days.

1. Contact Information
Name
Address
City  State
Zip Code
Phone   Email
2. Necklace Information
Date to be represented in necklace:   (_ _/_ _/_ _ _ _)  OR  Number to be represented in necklace  
Desired Length   If 'other' please enter length here:
Clasp   ( View Clasps )
3. Date Bead Selection - Please select one bead to represent your special date or number:
The cost of your custom necklace is based upon the type of bead select below.
$99.00 Price Group $149.99 Price Group $229.00 Price Group $329.00 Price Group
 agate  Agate
 Czech Glass  Czech Glass
 Dalmatine Jasper  Dalmatine Jasper
 fancy jasper  Fancy Jasper
 jade  Jade
 onyx  Onyx
 frosted onyx  Onyx - frosted
 Poppy Jasper  Poppy Jasper
 Turqoise  Turqoise
 Amethyst  Amethyst
 Aquamarine  Aquamarine
 Aventurine-Green  Aventurine - Green
 Aventurine-Orange  Aventurine - Orange
 Carnelian  Carnelian
 Citrine  Citrine
 freshwater pearl ivory  Freshwater Pearl - ivory
 freshwater pearl light green  Freshwater Pearl - lt green
 freshwater pearl peach  Freshwater Pearl - peach
 freshwater pearl pink  Freshwater Pearl - Pink
 freshwater pearl taupe  Freshwater Pearl - taupe
 freshwater pearl white  Freshwater Pearl - white
 freshwater pearl wine  Freshwater Pearl - wine
 garnet red  Garnet - Red
 Iolite  Iolite
 Lapis lazuli  Lapis Lazuli
 Moonstone  Moonstone
 peridot  Peridot
 Rhyolite  Rhyolite
 Rose Quartz  Rose Quartz
 garnet green  Garnet - Green
 Opal  Opal
 Swarovski Crystal  Swarovski Crystal - Olive
 Tourmaline  Tourmaline
 sapphire orange  Sapphire - orange
 sorry, no picture available.  Tanzanite
4. Spacer Bead Selection - Please select up to two beads for your spacers:
These are included in the price.
 agate  Agate
 Amethyst  Amethyst
 Aquamarine  Aquamarine
 Aventurine - Green  Aventurine - Green
 Aventurine - Orange  Aventurine - Orange
 bali barrel  Bali Barrel
 bali Beaded  Bali Beaded
 bali Beaded Triangle  Bali Beaded Triangle
 bali Braided Ball  Bali Braided Ball
 bali Braided Bicone  Bali Braided Bicone
 bali Circle Flat  Bali Circle Flat
 bali Floret  Bali Floret
 bali Mellon Flat  Bali Mellon Flat
 bali Square Smooth  Bali Square Smooth
 Carnelian  Carnelian
 Citrine  Citrine
 sorry no picture available  Chrysoprase
 donut 14kt gold filled  Donut-14kt gold-filled
 donut 14kt gold filled stamped  Donut - 14kt gold-filled Stamped
 donut peridot  Donut - Peridot
 donut silver  Donut - Silver
 fancy jasper  Fancy Jasper
 freshwater pearl ivory  Freshwater Pearl - ivory
 freshwater pearl light green  Freshwater Pearl - lt green
 freshwater pearl peach  Freshwater Pearl - peach
 freshwater pearl taupe  Freshwater Pearl - taupe
 freshwater pearl white  Freshwater Pearl - white
 freshwater pearl wine  Freshwater Pearl - wine
 garnet green  Garnet - Green
 garnet red  Garnet - Red
 jade  Jade
 Lapis lazuli  Lapis Lazuli
 Lapis lazuli heishi  Lapis Lazuli Heishi
 Moonstone  Moonstone
 Opal  Opal
 onyx  Onyx
 frosted onyx  Onyx - frosted
 peridot  Peridot
 Poppy Jasper  Poppy Jasper
 Rhyolite  Rhyolite
 Rose Quartz  Rose Quartz
 sapphire orange  Sapphire - orange
 Sorry, no picture available.  Tanzanite
 Tourmaline  Tourmaline
 Turoise  Turqoise
5. Earrings
Would you like Matching Earrings:    Yes        No
6. Additional Comments
Comments: 
Clasps
silver barrel
Barrel - Sterling Silver

gold lobster
Filigree - 14kt Gold-Filled

gold filigree
Elephant - 14kt Gold-Filled
silver spring
Spring - Sterling Silver

gold toggle
Toggle - 14kt Gold-Filled