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:



*Address Line 1:

Address Line 2:



*Zip/ Postal Code:


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

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

*Blouse Name:

*Fabric Type (Choose 1):

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) :

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

Ribbon Color (Pintucked Blouse Only):

Snap Color (Formal Ruffled Blouse Only):

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.)

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

Please use the MEASUREMENT CHART to help you accurately provide the following measurements:


*Back Length:
*Arm Length:
*Upper Arm: