TILE 96, INC.
TO PLACE AN ODRER, SAMPLE ORDER OR TO GET INFO FILL OUT THIS FORM

SAMPLE MINIMUM SERVICE CHARGE IS $10.00
Plus packaging and shipping. Charges differ, according to your location & item requested.
** THIS FORM WORKS ONLY WITH MICROSOFT EXPLORER BROWSER **
Note: Before you hit "SUBMIT FORM" make sure all fields marked with * are filled out!
Description Of Material:
Use description:
* ITEM NUMBER
exactly as noted on the WEB PAGE, approximate tile size, area to be covered in square feet, boxes ordering... etc.
* LAST NAME: 
* FIRST NAME: 
* ADDRESS:
* CITY:
* STATE:
* ZIP:
* COUNTRY:
* TELEPHONE:
    FAX:
* E-MAIL:
    HOW DID YOU FIND US?
* ADDRESS SHIPPING TO IS:
    MY CREDIT CARD
* MY SHIPPER IS:
THANK YOU FOR FILLING OUT THE FORM.

| your OWN name DOMAIN NAME |

We respect your privacy.
Your personal information will be used ONLY by Tile 96, Inc.
We do not lease or sell information you provided us.