Please fill out this form to the best of your ability, keeping your intentions and vision in mind. Every detail helps craft a personalized creation that aligns with your desires, emotions, or the message you wish to convey. If you’re unsure about certain sections, don’t worry! I'll work closely with you to refine your vision.  

General Information

Name: _____________________________________________________________________________  

Email & Phone: ____________________________________________________________________

Shipping Address: ___________________________________________________________________________

Preferred Contact Method: ☐ Email ☐ Text ☐ Other: ____________________________

Receiver's Name (if applicable): ____________________________________________________

Relationship: ___________________________ Birthday: _______________________________ 

Reason for Gift: __________________________________________________________________

Type of Creation

Personalized Keepsake Frames

(Includes: a personal photo or painting, up to 4 types of foliage, one creature embellishment, a personalized haiku, and an artist’s choice detail. Refer to the Patron’s Tribute page for price tiers.)

☐4x6 – $ ______ ☐5x7 – $ ______ ☐8x11 – $ ______ 

☐12x18 – $ ______ ☐18x24 – $ ______ ☐Other – $ ______

Resin Art Pieces

(Includes a base design with chosen colorants, intention setting, and one embellishment.)

☐Sets – $ ______ ☐Tiny Molds – $ ______ ☐Small Molds – $ ______ 

☐Med. Molds – $ ______ ☐Large Molds – $ ______ ☐Custom:__________________

Intention Pieces

Purpose of the Piece (select all that apply): ☐Happiness ☐Protection ☐Love ☐Healing

 ☐Gratitude ☐Psychic ☐Wealth ☐Luck ☐Other: ________________________________________

Intention Symbols, Herbs, Crystals, or Embellishments to Include:

 _____________________________________________________________________________________

Personal Energy or Message You'd Like to Imbue into the Piece:

 _____________________________________________________________________________________
 

Premium Collection

(Includes rare pigments, luminous effects, premium embellishments, and layered artistry.)

☐Exclusive Frame – $ ________ ☐High-End Resin Piece – $ _______ 

☐Luxury-Themed Custom Set – $ _______ ☐Other: _________________

Commissioned Artwork

(Fully bespoke experience with deep artistic collaboration.)

☐Painting or Mixed Media – $ ______ ☐Special Themed Resin Art – $ ______ 

☐Unique Keepsake – $ ______

Preferences & Choices

Design & Theme

Preferred Color or Color Palette: _________________________________________________

Opaque or Translucent Pigment (or both)? _________________________________________

Preferred Theme (celestial, forest, gothic, ethereal): _________________________________

Favorite Symbols or Motifs (moons, stars, butterflies): ______________________________

Level of Sparkle: ☐None ☐Subtle Shimmer ☐Bold Glitter ☐Other: ____________________

Do you prefer minimalistic or intricate? ☐Minimalistic ☐Intricate ☐Medium

Vision & Story

Briefly describe your vision for this keepsake: ___________________________________

_____________________________________________________________________________________

Is there a story, emotion, intention memory, symbols or sentiment you’d like this piece to convey?

_____________________________________________________________________________________

Additional Notes or Requests: ____________________________________________________

_____________________________________________________________________________________
 

Floral & Foliage Elements

(Up to 4 types included, additional selections below.)

Favorite Preferred Foliage: ☐Natural (Dried) ☐Artificial ☐Both

Favorite Plants: ___________________________________________________________________

Favorite Flowers: __________________________________________________________________

☐Surprise me! (Artist’s Choice)

☐Extra florals/foliage (+$15): _____________________________________________________

☐Special request florals (rare/sentimental) (+$25+):________________________________

Other Floral/Foliage Preferences: ________________________________________________

Embellishments

(Each piece includes one. Select extras below.)

Any preferred embellishments (lace, pearls, metallic accents)? 

_____________________________________________________________________________________

Favorite Animal: ☐Butterfly ☐Moth ☐Beetle ☐Raven ☐Owl ☐Fox ☐Bat

 ☐Other _____________________________________________________________________________

Favorite Mythical Creatures:

 _____________________________________________________________________________________

Favorite Crystals/Rocks/Gems/Minerals:

 _____________________________________________________________________________________

☐Mystical Elements (Fairies, dragons, celestial bodies, runes, sigils) (+$25): 

_____________________________________________________________________________________

☐Additional creature embellishments (+$10–$25 per extra): 

_____________________________________________________________________________________

Other Embellishments:

_____________________________________________________________________________________

Poetry & Inscription

☐Standard Haiku (Included) ☐Extended Haiku (24 lines) (+$20) 

☐Full Personalized Poem (No haiku limit) (+$50) ☐Custom Inscription (+$25) 

Other Poetry/Inscription Requests: ______________________________________________

Special Theme Add-Ons 

(+$35 per theme)

☐Gothic Elegance (dark)☐Celestial Magic (cosmic)☐ Nature’s Whisper (earthy) ☐ Whimsical Fauna (light) ☐ Alchemy & Arcana (symbolism) ☐Other: ________________

Display Enhancements

☐Ornate Frame (Vintage, Gothic, etc.) (+$40) ☐ Gold/Silver/Bronze Detail (+$30)
☐ Hand-Painted Frame Accents (Florals, celestial, mystical designs) (+$50)
☐ Shadowbox Frame (Dimensional enclosed look) (+$60)
☐ Custom Resin Display Base (For freestanding pieces) (+$45)

Other Frame/Resin Display Enhancements:

_____________________________________________________________________________________

Special Keepsake Additions

☐Mini Glass Vial (Pressed flowers or ashes) (+$25)
☐ Tiny Scroll with Handwritten Message (Aged parchment effect) (+$20)
☐ Embedded Gemstone or Crystal (Amethyst, Quartz, Obsidian, etc.) (+$35)
☐ Hidden Pocket Charm (Secret compartment for wishes or memories) (+$40)

Other Keepsake Additions:

_____________________________________________________________________________________

Practical Information

Review

Budget: $ ___________ Review Draft: ☐Yes ☐No Desired Deadline: ____________ 

Gift-wrapping ☐ No ☐ Yes... if yes, please specify: ____________________________________

Any other questions or concerns?

 _____________________________________________________________________________________

Confirmation

☐ I confirm that all the information provided in this form is accurate. I understand that my custom order will be created based on these details, and any changes requested after approval may result in additional charges and extended processing time.

☐ I acknowledge that I have read, understood, and agree to the Whimsy & Wards Policies regarding custom orders, payment, shipping, refunds, and product care. I understand that all sales are final.

Customer Name (Print): _______________________________

Customer Signature: _________________________________

Date: _______________________

Once completed, please submit this form along with any reference photos (if applicable) to elizabethpoje@whimsywards.com OR whimsywardsllc@gmail.com. Any personal materials will need to be shipped by the patron. You will receive an invoice and estimated completion time within 24-48 hours.

Thank you for helping craft a meaningful, one-of-a-kind treasure! I look forward to bringing your vision to life!