Your Name: _____________________________________________________________
Your Address: ___________________________________________________________
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Your Phone #: ___________________________________________________________
Your Email: ____________________________________________________________
Name original order was purchased under: _____________________________________
Order ID number, if known: ________________________________________________
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If you need a bracelet resized, enter the new size here: ____________________________
If you need a bracelet repaired, enter what needs to be repaired here: ________________
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If you want something on the bracelet changed, enter what you want here: ____________
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If you need another strand, name, etc. added onto a bracelet, enter that information here:
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Signature Date
