CUSTOM ONLINE ORDER FORM

(One Puzzle order per form. Submit additional forms for additional orders)

CONTACT INFORMATION

(*required field)

FIRST NAME

*

LAST NAME

*

MAILING ADDRESS

*

CITY

*

STATE

*

ZIP CODE

*

EMAIL ADDRESS

*

PHONE

* ex:5705551234

WOULD YOU LIKE US TO CALL YOU TO CONFIRM YOUR ORDER?

YES NO PLEASE CHOOSE                      * = Required field

ORDER INFORMATION

Please remember to e-mail your photos to custompuzzles@comcast.net

PUZZLE OR POSTER SIZE

PLEASE MAKE YOUR PUZZLE SELECTION #1 - 16" x 30" - 756 Piece Puzzle - $20.00 #2 - 16" x 20" - 504 Piece Puzzle - $20.00 #3 - 16" x 10" - 252 Piece Puzzle - $15.00 #4 - 11" x 17" - 308 Piece Puzzle - $15.00 #5 - 11" x 17" - 99 Piece Puzzle - $15.00 #6 - 8" x 10" - 48 Piece Puzzle - $10.00 #7 - 8" x 10" - 30 Piece Puzzle - $10.00 #8 - 4" x 6" - 24 Piece Puzzle - $7.50 #9 - 4" x 6" - 9 Piece Puzzle - $7.50 #10 - 8" x 10" - 48 Piece Magnet Puzzle - $10.00 #11 - 8" x 10" - 30 Piece Magnet Puzzle - $10.00 #12 - 4" x 6" - 24 Piece Magnet Puzzle - $7.50 #13 - 4" x 6" - 9 Piece Magnet Puzzle - $7.50 #14 - 4" x 6" - 24 Piece Post Card Puzzle - $7.50 #16 - 4" x 6" - 9 Piece Post Card Puzzle - $7.50 #16 - Large Poster (Up to 20" x 35") - $20.00 #17 - Small Poster (Up to 13" x 19") - $10.00

REAL PHOTO OR DIGITAL PHOTO

I will be sending you a original photo in the mail. I will be sending you a digital photo in E-MAIL PLEASE CHOOSE

SINGLE IMAGE FILE NAME

PLEASE PROVIDE IMAGE FILE NAME THAT YOU WILL EMAIL TO CUSTOM PUZZLES

2 SIDED PUZZLE OPTIONS

2 SIDED PUZZLE OPTION

SINGLE SIDED OR DOUBLE SIDED ? 1 SIDED PUZZLE OPTION 2 SIDED PUZZLE OPTION - ADD $5.00 TO TOTAL

SECOND IMAGE FILE NAME

PLEASE PROVIDE IMAGE FILE NAME THAT YOU WILL EMAIL TO CUSTOM PUZZLES

Not avaliable on Magnet Puzzles or Posters

COLLAGE PUZZLE OPTIONS

COLLAGE PUZZLE

DO YOU WANT A PUZZLE COLLAGE ? SINGLE IMAGE OPTION COLLAGE PUZZLE OPTION - ADD $10.00 TO TOTAL

(Please send minimum 5 Images)

2ND IMAGE NAME

3RD IMAGE NAME

4TH IMAGE NAME

5TH IMAGE NAME

PLEASE PROVIDE IMAGE FILE NAME THAT YOU WILL EMAIL TO CUSTOM PUZZLES

If more then 5 images, please use space provided below to list image names.

ADDITIONAL INFORMATION

Please include any additional information or instructions in this space.