First Name
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Last Name
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Address
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City
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Postal code
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State
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Phone
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Email
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Date of birth
What is your preferred method of contact?
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Phone
Email
Other
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? (Name) And what is their relationship to you?
Why have you chosen this keepsake(s)? Is there a special story attached to what you’re ordering?
Inclusions you're having crafted with.
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Breastmilk or Formula
Dried Placenta
Umbilical Cord/Stump
Hair
Pet Fur
Ashes
Flowers
Fabric
Other
When having your keepsakes made with ashes would you like them visible or hidden?
Visible
Hidden
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
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Please describe any specifics we need to know for your order.
Do you have any other stories or information 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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