BACKSPLASH DESIGN SELECTION FORM
Customer Name
*
First Name
Last Name
Phone Number
*
E-mail
*
example@example.com
TILE SELECTION
Name
Finish
Size
Layout
Grout
Kitchen Backsplash Tile #1
Kitchen Backsplash Tile #2
Tile Edge
Finish
Thickness
Location
Notes:
SIGN OFF
Please sign off on the selections that you have made.
Customer Signature
*
I hereby sign off that the selections made are correct.
Designer Signature
*
Submit
Should be Empty: