Name *

First Name

Last Name

Address *

Where you'd like to receive your kit(s).

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Best one to use to contact you.

(###)

###

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What Kit(s) would you like to order? *

Kit 1 - Bronze AB - $45.00

Kit 2 - Soft Gold - $45.00

Kit 3 - Gunmetal - $45.00

Kit 4 - Soft Silver - $45.00

None

Would you like to order 14mm cushion cut CZ(s)? *

NOTE: You will need 1 per bracelet.

Yes

No

Would you like to order 10mm round CZ(s)? *

NOTE: You will need 2 per bracelet.

Yes

No

Would you like to order any other supplies? *

Yes

No