Your Name (First & Last Please):

Phone Number (optional: ###-###-####)

E-mail address?

Type of Outfit or Accessory:

Additional Accessories? (If ordering an outfit, i.e. choker,hairties,moccs, etc):

Color 1 (Background):

Color 2 (usually a main accent color):

Color 3:

Color 4:

Color 5:

Color 6:

Color 7:

Pattern 1 (Main pattern wanted):

Pattern 2 (Usually an accent pattern):


Will you be providing a drawing of what you have in mind?: (If you answer "Yes" please send an email with ideas or pattern to us after filling out this form)

If you answered "No" above, would you like us to create a pattern for you?:


Would you like insurance for your package (It is optional, but not included in the deposit for S&H, the cost will range from $5.00-$25.00 depending on the cost of your order):

Please List your measurements, as according to the measurements page (Please list all measurements needed to complete your order in a timely manner.)

"Gift Certificate" or Coupon Code:

Any additional Comments up to 500 characters? (Please provide a way for us to contact you if you did not provide an e-mail address)
I have given the specific measurements asked forYes, I have given Specific Measurements Asked For I have read and understand the FAQ page and will adhear to the policies?Yes, Agree To The Policies Written In The FAQ section of the site. I am fully liable for the measurements and information I provide?Yes, I am fully liable for the measurements and information I provide. I understand that if I am ordering for someone else, I am still liable for all the information I provide, it is not Cultural Touch's fault if I provide the wrong information?Yes, I am fully liable for the measurements and information I provide for someone else.