SHELLEY MILLER

Street Address

MONTREAL

Phone Number

Your Custom Text Here

Mosaic Kit Order Form

Name

First Name

Last Name

Phone number

Mailing Address (for postage delivery)

Choose your mosaic preference (based on supplies)

Big Bang Design

Meltdown Volcano

Space Banana

Pick Axe - Light Blue

Space Invader - Crab

Space Invader - Squid

Quantity of each kit (NOTE: Maximum of 3 per order. Email to inquire about bulk orders)

Checkbox

Will pick up

Opt for delivery (charges apply)

Message (Additional information or requests)

NOTE: The colours and textures of pieces vary in each kit. Colours may not match exactly to images shown below.

4889 Clark Street
Montreal, Quebec