Item Description
Ceramic Glaze/Color
Or Bronze Finish
Frame Style
Qty.

Unit Price
Total
example: 6" Ceramic Bear
mustard/matt
Legacy
1
150.00
150.00
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Sub-Total
$______
 
Add Michigan Sales Tax of 6% on orders shipped in Michigan
$______
 
Total number of tiles.
______
 
Add $ 10.00 per tile for shipping.
$______
 
TOTAL
$______
Full Name:
  
Address:
  
City/State/Zip
  
Phone:
  
Email:
  

NOTE: This form should print from your computer on an 8 1/2" x 11" page. Complete the form and fax to Northern Lights and Lifestyles. Please include your phone number and have your credit card and shipping information available. Visa, Master Card, Discover and American Express are accepted.
We look forward to your order.

LEWELLEN STUDIO INFORMATION PAGE

FOR FRAMED CERAMIC & BRONZE TILES • FOR ART NOUVEAU SERIES

FOR CERAMIC TILES • FOR CERAMIC GLAZE & COLORS • FOR BRONZE TILES

FOR ORDER FORM