Custom Beaded Jewelry Request Form

What are the names of the gemstone beads you are looking for? *Please list any and all of the stones you are interested in

What kind of jewelry are you looking for? (Bracelet, Necklace, Earrings or Anklet)


What size are you looking for? (Length in inches using 1/4" intervals)

Bracelets, Necklaces & Anklets: Please select a clasp type
Lobster Claw Clasp	Lobster Claw w/ 2" Extender	Toggle Clasp

Earrings: Please select a ear hook type
Standard French Wire *style may vary	Leaver Back Hooks

How many of this item are you looking for?

Please check the size of the beads you prefer:
Small Size Beads Medium Size Beads Large Size Beads Extra Large Beads

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.