Legacy Foundation Tiles Order Form

First Name *

Last Name *

Phone *

Email *

Company Name (If Appliable)

Tile Size *

4 x 4 ($100)

6 x 3 ($250)

6 x 6 ($500)

Logo Upload

Description of what you want to appear on the tile: *

Collect Payment *

$ 100

$ 250

$ 500

Other amount

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