NAME:___________________________________________________________________________
ADDRESS:________________________________________________________________________
PHONE NUMBER:_________________________________________________________________
E-MAIL:__________________________________________________________________________
NAME OF TILE:_______________________________QUANTITY:______COLOR:______________________
NAME OF TILE:_______________________________QUANTITY:______COLOR:______________________
NAME OF TILE:_______________________________QUANTITY:______COLOR:___________________
NAME OF TILE:_______________________________QUANTITY:______COLOR:______________________
NAME OF
TILE:_______________________________QUANTITY:______COLOR:______________________
NAME OF
TILE:_______________________________QUANTITY:______COLOR:______________________
NAME OF
TILE:_______________________________QUANTITY:______COLOR:______________________
NAME OF
TILE:_______________________________QUANTITY:______COLOR:______________________
NAME OF
TILE:_______________________________QUANTITY:______COLOR:______________________
NAME OF
TILE:_______________________________QUANTITY:______COLOR:______________________
We will fax you back a confirmation of your order
with the amount including shipping and expected time of arrival.
Thank you for your business!
VISA or M/C NUMBER:______________________________________________ EXPIRES:___________
SIGNATURE:____________________________
Notes or special instructions: