Urth Elements Customized Ring Order Form 13241 Sandhurst Pl Santa Ana Ca 92705 Phone (714)392-0767/(949)436-1414
Customer Information Name
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Address: ___________________________________________ Phone: Daytime ______________Evening_________________ Email Address:_______________________________________ -------------------------------------------------------------------------------------------------Please write in your selections below. Any shell can be matched with any stone we offer and placed in any of our designs. ORDER #1 Shell ____________________________ Stone ____________________________ Design ____________________________
ORDER #2 Shell ____________________________ Stone ____________________________ Design ____________________________
Once we receive your request we will contact you to finalize and confirm your order. Upon your approval of design and price, payment may be submitted.
**Payment should not accompany this order request.** ***Order request may take up to one week to process.***