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		Requestor Name:
		
		Phone:
		
		E-mail:
		
		Ship-to Address:
		
		Material:
		
					 Glass

					 Ceramic/Porcelain Tile

					 Honed stone

					 Natural Stone

					 Wood

					 Other (Explain below)

		Project Overall Size (Inches):
		
				Width:
				 (just the number)
			
				Height:
				
		Number of colors:
		
					 One or two

					 Three

					 Four

					 More than four

		Image Artwork:
		
					 Customer supplied

					 Photo

					 Original Artwork

					 Digital Image

		File Size:
		
		Customer Specified Image (Describe):

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