Name *

First Name

Last Name

Phone

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name *

First Name

Last Name

Phone

(###)

###

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Address

Address 1

Address 2

City

State/Province

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Gem

Champagne Diamonds (C3 Si1)

Australian Parti Sapphires

Australian Teal Sapphires

Lab-Grown Diamonds (E-F VS)

Natural Diamonds (F Si1)

Gold

18ct Yellow Gold

18ct White Gold

18ct Rose Gold

Custom

Single Charm Only

Single Charm & Huggie Only

Pair of Charms

Pair of Charms & Huggies