Please refer to the How to Order section before completing this form. The How to Order section explains the entire order process, including payment and shipping.

----------------------------------------------------- PERSONAL INFORMATION -----------------------------------------------------

* indicates required field

*First Name:

*Last Name:

*Gender: Female Male [Choose]

*E-mail:

*Address Line 1:

Address Line 2:

*City:

*State: [Choose State] Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming [Outside of USA]

*Zip/ Postal Code:

*Country:

Check here if you would like to be on my Mailing List:

--------------------------------------------------------- ITEM INFORMATION ---------------------------------------------------------

*Blouse Name:
Lacey Lolita Blouse
Pintucks and Ribbons Blouse
Formal Ruffles Blouse

*Fabric Type (Choose 1):
Solid
Print

Solid Color (Please be specific- ie: dark blue):

----------- OR --------------

Print (Please describe the type of print you would like me to select for you- ie: black background with pink flowers):

Ruffled Lace Color (Lacey Lolita and Pintucked Blouse Only. Note: The Beading Lace on the Pintucked Blouse is available in White only) :
White
Black

*Button Color (Please be specific- ie: dark blue):

Ribbon Color (Pintucked Blouse Only):

Snap Color (Formal Ruffled Blouse Only):
White Pearl Ivory Pearl Red Pearl Gray Pearl Black Pearl [Choose Color]

Bowtie Color or Print (Formal Ruffles Blouse Only):
Please describe the solid color or print you would like for your bowtie.
(If left blank, I will use the same fabric as your blouse.)

Comments: (Please include any additonal questions/ comments you may have. I will e-mail you shortly to answer any questions.)

------------------------------------------------------------------ SHIPPING ------------------------------------------------------------------

Shipping: (Standard shipping By the US Postal Service is free within the continental United States. If you desire another form of shipping, fill out the "other" box below. Shipping to areas outside of the Continental USA, or any other type of shipping other than USPS, is subject to an additional shipping charge. If you live outside of the continental USA, you may leave this section blank. I will inform you of the shipping costs when I send you a confirmation e-mail requesting payment.)
USPS (Free within the Continental USA)
Other (Please Specify)

------------------------------------------------------------- MEASUREMENTS -------------------------------------------------------------