Order Form for Custom Photo Tiles from Tilepix

Tilepix Custom Tile Order Form

Print and use this form to order your custom photo tiles from Tilepix.

Customer information:
Name:	_______________________________________________________________
Email:	_______________________________________________________________
Address:	_______________________________________________________________
City:	___________________	State: ______	Zip:	_________
Telephone:	_____ / _____ _______

Order Information:

Tile size:

__ 4 X 4

# of tiles:

___

X $9.00 =

$ _________

Tile size:

__ 6 X 6

# of tiles:

___

X $11.00 =

$ _________

Tile size:

___ 6 X 8

# of tiles:

___

X $13.00 =

$ _________

Tile size:

___ 8 X 8

# of tiles:

___

X $15.00 =

$ _________

___ Other

(Contact us)

Total:

$ _________

Shipping:

1 - 4 Tiles

Add 50%

_______

5 - 9 Tiles

Add 20%

_______

Total:

$ _________

Method of Payment:

We accept all major credit cards via PayPal. Other accepted methods of payment are: Check, Money Order, or COD. Please make checks payable to:
Ed Eisenberger

Special Instructions:

Use the space below for any special instructions. If we have questions about your order, we will call or send you an email for clarification. Note — all photographs and other material sent to us will be returned with your order.

Mail this completed order, along with your photos, to:

Imageworks
32700 Mountain Spring Road
Sheridan, OR 97378