64 Forth Street, PO Box 885
Invercargill, 9840 
New Zealand 

Phone:   +643 2145012        
Email:     sales@escapeglass.co.nz

For large and custom pieces please answer these questions
for us to help you get the right information. (Not essential, but encouraged!)

1) Name:
2) Address of installation :
3) Contact phone number :
4) Approximate size of splashback/Glass area :
5) Number of cutouts for powerpoints, handles or rangehoods :
6) Are you ready for a site measure now? :
7) Where did you hear about our splashbacks? :
(Google, friend, facebook, pinterest, instagram or other?) 
8) Any other comments relevant to your splashback** :

** If you are interested in an Image on Glass please email the Image that you are interested in using for your splashback to  sales@escapeglass.com