I start off with sketches, sometimes very rough sketches. Process can be messy, but that's why I love it.
I then bring the sketch into Adobe Photoshop, make a few adjustments and then open the sketch in Adobe Illustrator. Then, I use my Wacom tablet to draw over my sketch. I go back and forth between the Wacom tablet and my mouse.
The final letterpress printed / foil printed cards - printed on a Vandercook #3 Proof Press or a Heidelberg Windmill. Notice the offset printing in the color letterpress prints, this is my favorite part of a final piece!