Special Request Form

Name the stone or stones you are looking for:


What kind of jewelry are you looking for? (Bracelet, Necklace, Ring, Pendant, etc...)


What size are you looking for? (Length of bracelet or necklace, Ring size, etc...)


How many of this item are you looking for?

Please check the size of the stones you prefer:
Small Size Stones Medium Size Stones Large Size Stones Extra Large Stones

Please check the price range that best applies:
Less than $25.00 $25.00 - $50.00 $50.00 - $100.00 $100.00 - $200.00 Price does not matter

If you need this item by a specific date, please note the date you need to receive this item by:

Please list any other specifics that might help us to better find the jewelry you are looking for:


Please enter your email address so we may contact you:


Email is the easiest method to allow customers to view special request items. If you do not have an email address or if you wish to be contacted by phone, please list your phone number:

For Outlook Express, Microsoft Outlook and other Local E-mail Programs - Use the button below to send this form to us via e-mail. After you click the button, your local e-mail program will open and auto send this form to us.

For Hotmail, Gmail, and other Web Based E-mail Programs- When you are done with the form, right click on the page and click select all, then hold the Control button down and press the C key at the same time to copy the page. You can also right click again and click copy to copy the page. Next open your web based e-mail host and create a new message to sales@themysticjewel.com with the subject "Special Request for Jewelry". Paste the form into the new email and send it. You can also save this web page as a text file and send it as an attachment.