Gustin Ceramics Tile Production: Order Form

		Order Form

Please print and fill out this form and send to: Gustin Ceramics Tile Production, 231 Horseneck Road, South Dartmouth, MA 02748. Or fax to (508) 636-5099. This form is also available as a PDF.

We now accept Visa, Mastercard and Discover cards. Simply call in your card number to our office.

Contact Information
Contact name:	____________________________________
Contact phone:	____________________________________
Contact company:	____________________________________
Date:	____________________________________
P.O. number:	____________________________________
Billing Address
Name:	____________________________________
Address:	____________________________________
City:	____________________________________
State:	____________________________________
Zip:	____________________________________
Telephone:	____________________________________
Fax:	____________________________________
Email:	____________________________________
Shipping Address
Name:	____________________________________
Address:	____________________________________
City:	____________________________________
State:	____________________________________
Zip:	____________________________________
Telephone:	____________________________________
Fax:	____________________________________
Email:	____________________________________

Quantity	Tile Size	Glaze #	Price per tile	Total











Subtotal
5% sales tax (Massachusetts orders only)
Total*
50% Deposit Due

*Please remember that shipping costs will be added to this total, based on the quantity of tile ordered and the shipping method selected.