Keepsake Jewelry Form Fields marked with an * are required Divider HTML GF = Gold Filled. RGF = Rose Gold Filled. SS = Sterling Silver. Original Heartbeat Necklace or Bracelet $89-$139 GF $139 RGF $139 SS $89 Necklace Length: 16" 18" 20" Bracelet Length: 6.0" 6.5" 7.0" 7.5" 8.0" 8.5" 9.0" Divider Original Cherished Heart Necklace $89-$139 GF $139 RGF $139 SS $89 Necklace Length: 16" 18" 20" Heart Position: Left Middle Right Divider Heartbeat Pendant Necklace $69-$139 GF $139 RGF $139 SS $89 ST $69 Necklace Length: 16" 18" 20" Text Engraving (1 line, up to 18 characters per line) 18 of 18 Character(s) left Divider Additional Heartbeat Pendant(s) $40-$90 ** GF $90 RGF $90 SS $50 ST $40 Quantity: Text Engraving (1 line, up to 18 characters per line) 18 of 18 Character(s) left Divider Copy Heartbeat Bar Bracelet $69-$139 GF $139 RGF $139 SS $89 ST $69 Bracelet Length: 6.0" 6.5" 7.0" 7.5" 8.0" 8.5" 9.0" Text Engraving (1 line, up to 40 characters per line) 40 of 40 Character(s) left Divider Copy Copy Heartbeat Bar Necklace $69-$139 GF $139 RGF $139 SS $89 ST $69 Necklace Length: 16" 18" 20" Text Engraving (1 line, up to 18 characters per line) 18 of 18 Character(s) left Divider Copy Copy Copy HTML Additional Heartbeat Bar Pendant $40-$90 ** (To create Double Heartbeat Bar Necklace) GF $90 RGF $90 SS ST $40 Necklace Length: 16" 18" 20" Text Engraving (1 line, up to 18 characters per line) 18 of 18 Character(s) left Divider Copy Copy Copy Copy Original Voice Soundwave Necklace or Bracelet $89-$139 GF $139 RGF $139 SS $89 Necklace Length: 16" 18" 20" Bracelet Length: 6.0" 6.5" 7.0" 7.5" 8.0" 8.5" 9.0" Divider Copy Copy Copy Copy Copy HTML Double Original Heartbeat Necklace $139-$229 (Top and bottom can be different materials) Top Heartbeat: GF +$45 RGF +$45 SS Included Bottom Heartbeat: GF +$45 RGF +$45 SS Included Necklace Length: 16"/18" 18"/20" Divider Stainless Steel Dog Tag $69-$89 Photo Engraving $99 Heartbeat Engraving $69 Style: 16" Snake 18" Snake 20" Snake 24" Ball Chain Keyring Single Line Text 17 of 17 Character(s) left Single Line Text 17 of 17 Character(s) left Single Line Text 17 of 17 Character(s) left HTML Text Engraving (3 lines, up to 17 characters per line) Divider Copy HTML Mini Stainless Steel Heartbeat Dog Tag $69 Style: 16" Snake 18" Snake 20" Snake 24" Ball Chain Keyring Single Line Text 17 of 17 Character(s) left Single Line Text 17 of 17 Character(s) left Single Line Text 17 of 17 Character(s) left HTML Copy Text Engraving (3 lines, up to 17 characters per line) Divider Copy Copy Stainless Steel Money Clip $69-$99 Photo Engraving (no text engraving) $99 Heartbeat (up to 3) $69 Single Line Text 18 of 18 Character(s) left Single Line Text 18 of 18 Character(s) left HTML Text Engraving (2 lines with 1 heartbeat OR 1 line with 2 heartbeats OR up to 18 characters per line) Divider Copy Copy Copy HTML Stainless Steel Heartbeat Charm Bracelet or Necklace $69 Charm: Tilted Heart Oval Traditional Heart (necklace only) Bracelet Size: 7.0" 8.0" 8.5" 9.0" Chain Style: 16" Snake 18" Snake 20" Snake 24" Ball Chain Single Line Text 11 of 11 Character(s) left Single Line Text 11 of 11 Character(s) left HTML Text Engraving (2 lines, up to 11 characters per line) Divider Copy Copy Copy Copy Stainless Steel 4-Sided Pendant $69-$99 Up to 4 Sides Engraved (heartbeat or text) $99 Up to 2 Sides Engraved (heartbeat or text) $69 Style: 16" Snake 18" Snake 20" Snake 24" Ball Chain 4" Keychain Single Line Text 20 of 20 Character(s) left Single Line Text 20 of 20 Character(s) left HTML Text Engraving (20 characters per line) Divider Heart Charm Special Necklace $69 Keyring $59 Style: 16" Snake 18" Snake 20" Snake Single Line Text 18 of 18 Character(s) left Single Line Text 18 of 18 Character(s) left HTML Text Engraving (1 line, up to 18 characters per line) HTML Include a Birthstone Charm: Add +$8 Quantity: Birth Month(s): Divider Copy HTML Additional Heartbeat Charm(s) $50 ** Charm: Tilted Heart Oval Traditional Heart (necklace only) Quantity: Single Line Text 11 of 11 Character(s) left Single Line Text 11 of 11 Character(s) left HTML Text Engraving (2 lines, up to 11 characters per line) Divider Copy Copy HTML Bracelet Birth Stone Charm $8 **Can be added to any necklace or bracelet Quantity: Birth Month(s) Divider Copy Copy Copy Sterling Silver Gemstone Heartbeat Ring $79 Heartbeat Both Sides of Gem Heartbeat Left, Text Right Heartbeat Right, Text Left Size (4-10): Text Engraving (8 characters) 8 of 8 Character(s) left Divider Copy Copy Copy Copy Heartbeat Band Rings $89 Sterling Silver Comfort Fit Band (sizes 4-13) Stainless Steel Comfort Fit Wedding Band (sizes 4-13) Stainless Steel Men’s Style Band (sizes 5-14) Size: Style: Women’s Style Font Men’s Style Font Text Engraving (25 characters) 25 of 25 Character(s) left Divider Copy Copy Copy Copy Copy Shipping/Processing Preferences * Free Shipping (4 weeks) - FREE! Priority Processing (2 weeks) - $25 Rush Priority Processing (1 weeks) - $50 HTML *Rush Priority is $75 for one month before Valentine’s Day, Mother’s Day, Father’s Day, and Christmas. Rush Priority - $75 HTML Only one recipient per priority or rush priority order. HTML Receipt times from date order is place on website. First Name * Last Name * Address * Apartment/Suite/P.O. Box * City * US States * - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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 Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Zip * Email * Phone * Upload your heart beat image * Select Image Cancel I (customer name) * HTML confirm all fields of this order form (name, address, order information, etc.) HTML are correct and accurately reflect my choices for my keepsake purchase. I understand I cannot make changes after placing my order and that correcting any errors after jewelry is in production may result in additional charges. I understand that all orders are custom made and non-refundable. HTML Signature: ___________________________________________________ Date: * HTML Contact us for special order requests at info@goldenviewultrasound.com.** Additional Pendants, Bars, and Charms only available with purchase of original item (pendant necklace, bar necklace, or charm bracelet). If you are a human seeing this field, please leave it empty.
