Wild Tiles Purchase Form

Please print out this page, then fill-in and return the form

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Order Form

Item Description	Reference Number	Quantity	Price	Total
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			Order Total	..................

Name................................................................................................................................

Address.............................................................................................................................

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E-mail address (optional)...................................................................................................

Telephone number (optional)............................................................................................

I have enclosed the sum of .................payable to Jan Kilpatrick. Please send me confirmation of my purchases and dispatch to the address above.

I found out about Wild Tiles through.....................................................................................

Send to:

Jan Kilpatrick, Wild Tiles, Cul Mor, Elphin,
Near Ullapool, Sutherland, IV27 4HH.
Tel : 01854 666279
Email : jan@wildtiles.co.uk
www.wildtiles.co.uk

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