CUSTOM JEWELRY ORDER FORM

Please fill out this form to order a custom jewelry piece. An estimate of costs involved will be emailed to you at the email address you provide below. No payment will be requested at this time. Once you have approved your estimate, an invoice will be emailed to you for a 50% non-refundable deposit, which can be paid via PayPal, Credit Card via PayAnywhere (Phone and Mail Orders Only) or by Check or Money Order. Note that production will begin once deposit has been received and has cleared through the bank. Please refer to the Shipping Form to select which shipping option you would prefer. If you are local on the San Francisco Peninsula, your item can be hand-delivered at no cost to you.

Customer Information Name: Address: City, Zip: Phone: Email: Birthday: (Month/Day)

Ordered For: Ship to Address: City: State or Province: Country: Deliver By Date:

Price Range: Minimum: $__________________ Maximum $_________________ Order Details Type of Jewelry Desired: Necklace, Length: 16 18 20 22 24 Other: _____ Bracelet, Length: ______________ Ankle Bracelet, Length: __________ Earrings: Pierced Clip Adjustable Ring Style of Jewelry Desired: Necklace, Shaker Strand Shaker/Strand Combo Link/Chain Torsade A necklace similar to Item No _____________ Bracelet, Shaker Strand Charm A bracelet similar to Item No _______________ Earrings, Shaker Straight Chandelier Earrings similar to Item No ________________

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Ring, Similar to Item No __________________ Metal Desired Silver Tone Only Sterling Silver Only Silver Tone/Sterling Combo Gold Tone Gold Tone Mixed w/ 14k Gold Fill Copper Gunmetal Gray Black Other/Mixed: __________________________________________________________

Stones Desired (See Chart) Agate Green Red Orange Yellow Browns Purple Black Pink White Green Blue/Green

Amazonite

Amber Red Orange Yellow Blue Browns Amethyst Light/Lavender Aquamarine (Light Blue) Aventurine Azurite Green White Blue Brown Pink Dark/Purple

Electric Blue Blue/Green Turquoise

Bloodstone (Green Jasper dotted with bright red spots of iron oxide) Carnelian (reddish/brownish orange) Chaldecony (Most Any Color, Please Indicate __________________________) Chrysocholla (Blue/Green Mix) Citrine (Golden/Yellow) Pink White Yellow Black

Coral Red

Garnet (Burgundy) Hematite (Silvery Gray to Black) Jade Light Green (Imitation) Dark Green (Real) Dark Green (Imitation) White Jasper Browns Greens Red

Labradorite (Silvery Gray) Lapis Lazuli (Dark Blue)

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Lava Stone (Black) Malachite (Green) Real Imitation Moonstone (milky, translucent with white/pink/yellow/blue sheen) Obsidian (Black often with Ribbons of White) Onyx (Black) Opal Pearls (Specific Type, if Applicable): ___________________________ Real Imitation Freshwater

Peridot (Lime Green) Quartz (Clear Crystal) Tiger Eye (Golds and Earthy Browns) Other: _______________________________________________ Other: _______________________________________________ Custom: _______________________________________________ _______________________________________________

Crystal Elements
Swarovski will be your more expensive but highest quality crystal components, whereas Preciosa Crystal matches Swarovski the closest in quality and look at a lower price than Swarovski. Czech Crystal rondelles are also very beautiful and are your lower priced crystals.

I Prefer: Swarovski

Preciosa

Czech Rondelles

Colors: (See Color Chart) ___________________________________ _________________________________________________________ Shapes: Bicone Round Cube Mixed Small (6mm) Medium (8mm) Large (10mm) Mixed Swarovski Pearls Colors: (See Color Chart) ___________________________________ _________________________________________________________

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Method you will be using for payment: PayPal Credit Card Via PayAnywhere (Phone/Mail Orders Only, Visa, MC, Amex and Disc) Check Money Order
50% is due upon approval of the estimate and 50% is due upon completion. Completion specifies the time after you nd have reviewed photos of the work and approved it. Final work will be issued upon 2 payment. Checks and Money Orders must be made out to Mark Thaler. There is a $35 fee for checks returned by the bank.

Additional Comments: __________________________________________________________

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Domestic Shipping Do Not Ship Until: (Specify Date, otherwise leave blank for immediate shipment) ________/________/_________ Recipient Information Name (First Last): Address 1: Address 2: City: State: Zip Code: Country: USA Phone:** **some shipping services require a recipient phone number Gift Message (if applicable):

Send Gift Anonymously? Yes No Gift Wrap Item? ($2.00 additional charge) Yes No Occasion (if applicable): Birthday Wedding Anniversary Graduate Sweet 16/Quinceanera Congratulations Christmas Hanukkah New Year Valentine Get Well Other: _____________________

Green Packaging Only (Paper materials only) Other Comments/Instructions:

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Select Service (Rates are based on rates provided by each shipping service) Carrier Service First Class Priority Express Timeframe 2-3 Days 2 Days 1 Day Cost $3.99 $5.15 $39.95

Insurance ($1.95 extra) Recommended for items valued at over $50.

Insured mail provides coverage against loss or damage up to $5,000. Available for Priority Mail, First-Class Mail, Standard Post and Media Mail. Items may not be insured for more than their value.

Certified Mail ($3.10 extra)

Certified Mail provides proof of mailing at the time of mailing and date and time of delivery or attempted delivery. A delivery record is maintained by the USPS.

Signature Confirmation ($2.70 extra)

Signature Confirmation service provides the mailer with information about the date and time an article was delivered and, if delivery was attempted but not successful, the date and time of the delivery attempt. A delivery record, including the recipient's signature, is maintained by the USPS and is available, via fax or mail, upon request. No acceptance record is kept at the office of mailing.

Registered Mail ($12.05 extra)

Provides maximum protection and security for valuables. It provides the sender with a mailing receipt and a delivery record (i ncluding recipients signature) is maintained by the USPS for a specified per of time. A record of mailing is maintained by the Postal Service. Postal insurance is provided for articles with a declared value up to a maximum of $25,000. Only items with no declared value may use registry service without insurance.

Restricted Delivery ($4.75 extra)

Permits a mailer to direct delivery only to the addressee or addressee's authorized agent. The addressee must be an individual specified by name.

Return Receipt ($2.55 extra)

A return receipt provides the sender a postcard or electronic notification, via email, with the date of delivery and recipient's signature.

Certificate of Mailing ($1.10 extra)

Certificate of Mailing provides evidence of mailing and must be purchased at time of mailing.

Please Specify:
Please email shipping receipts to me at the email address specified on the other side of this form. Please have shipping receipts mailed to me at the following address:
_________________________________ _________________________________ _________________________________ _________________________________

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International Shipping Do Not Ship Until: (Specify Date, otherwise leave blank for immediate shipment) ________/________/_________ Recipient Information Name (First Last): Address 1: Address 2: City: Province: Postal Code: Country:
(IMPORTANT: See Reverse for Restrictions)

USA

Gift Message (if applicable):

(If in another language or alphabet, this portion will be scanned and printed for the recipient to read.)

Gift Wrap Item? ($2.00 additional charge) Yes No Occasion (if applicable): ___________________________________________

Green Packaging Only (Paper materials only) Other Comments/Instructions:

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Select Service (Rates are based on International Rates provided by USPS.)

Note:

Carrier

Service First Class Intl Priority Intl Express Intl

Timeframe Varies by Dest. 6-10 Bus. Days 3-5 Bus. Days

ALL CANADA OTHER $9.50 $15.08 $19.95 $37.35 $23.95 $51.85

Total items valued at over $400 must be sent by International Express. Tracking for International Orders is available electronically/via email.

RESTRICTIONS / REQUIREMENTS Countries Which Require Jewelry Be Sent Only By 1st Class Registered Mail: Afghanistan, Aruba, Burkina Faso, China, Curacao, Faroe Islands, French Guiana, French Polynesia, Gambia, Greece, Guadeloupe (Includes Saint Bartholomew and Saint Martin), Japan, South Korea, Macao, Sint Maarten, Somalia, Uganda, Zambia Countries Which Require Insured Priority Shipping for Jewelry: Australia, Ghana, Hungary, Italy, Kyrgyzstan, Liberia, Malaysia, Nicaragua, San Marino, Republic of Serbia, Spain, Sri Lanka, Suriname, Turkey, United Arab Emirates Countries Where Shipping Jewelry is PROHIBITED: Armenia, Bangladesh, Benin, Bolivia, Botswana, Brunei Darussalam, Bulgaria, Burma, Cape Verde, Central African Republic, Chad, Chile, Costa Rica, Dominican Republic, Eritrea, Estonia, Ethiopia, Falkland Islands, Gabon, Republic of Georgia, Northern Ireland (Includes England, Scotland, Wales, Northern Ireland, Guernsey, Jersey, Alderney, Sark, and the Isle of Man), Guatemala, Guinea, Guyana, Haiti, Honduras, India, Indonesia, Iran, Iraq, Kazakhstan, Kenya, North Korea, Republic of Kosovo, Laos, Latvia, Lebanon, Lesotho, Libya, Lithuania, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mexico, Morocco, Mozambique, Nepal, Pakistan, Panama, Peru, Philippines, Pitcairn Island, Poland, Portugal, Qatar, Reunion, Romania, Saudi Arabia, Senegal, Seychelles, Singapore, Sudan, Swaziland, Syrian Arab Republic, Tajikistan, Tanzania, Thailand, Togo, Tunisia, Turkmenistan, Turks and Caicos Islands, Ukraine, Uruguay, Venezuela, Vietnam The country of Cyprus only allows jewelry under license of Cypress Central Bank. In Yemen, Gift Value Cannot Exceed $85 Registered Mail ($12.95 extra) See Above Restrictions/Requirements
Registered Mail (International) is a service that allows you to register certain international mail for additional protectio n and security. Features of this service include: A mailing receipt is issued by office of mailing. Registered Mail service provides the sender with a mailing receipt, and upon request, when available, electronic verification that an article was delivered, or that an attempt at delivery was made. Registered Mail service is handled separately from all other mail, and records are kept by registry number. In destination countries, Registered Mail items are handled according to their own internal procedures. Return receipts may also be added. Padded envelopes are accepted for International Registered Mail items.

Certificate of Mailing ($1.10 extra)

Certificate of Mailing provides evidence of mailing and must be purchased at time of mailing.

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Please mail this completed form to: Mark Thaler 234 Broadway, Unit D Millbrae, CA 94030 Or it may be scanned and emailed to: markalino@outlook.com Questions? Please contact me at (650) 271-8421 or email markalino@outlook.com Visit my ArtFire Studio at http://markalino.artfire.com Find me on Facebook at http://www.facebook.com/MarkalinoVintage Tweet me at http://twitter.com/impassionedart Pin me on Pinterest at http://pinterest.com/markalino