First Name
Last Name
Address
City
Postal code
State
Country
Country
Phone
*
Email
*
Date of birth
What is your preferred method of contact?
Phone
Email
What is your Order Number? (You can find this on your order confirmation sent to you by email. If you have yet to receive your order summary please email us at
[email protected]
Who do the inclusions belong to?
Why have you chosen this keepsake(s)? Is there a special story attached to why and what you're ordering?
What inclusions are you having added to your keepsake(s)?
Breastmilk or Formula
Dried Placenta
Umbilical Cord / Stump
Embryos
Hair
Pet Fur
Ashes
Flowers
Fabric
Other
When having your keepsakes made, would you like the inclusion visible or hidden?
Hidden
Visable
What colour/s would you like your piece crafted with? Please be descriptive using words such as transparent, tint, solid colour, pale, pastel, bold, heavy, light, swirled with etc. to describe each colour. We work with Pearl (white), Silver, Gold, Black, Pink, Purple, Blue, Green, Yellow, Orange *
Please describe any specifics we need to know for your order.
Do you have any other information or story you'd like to share?
Would you like to be tagged on our socials when we post pictures of your keepsakes?
We'd love to know how you heard about us.
Facebook
Instagram
Website
Google
Friends & Family
Other
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