Hart's Hearth Order Form
For Fax and Mail Orders
Print This Page.  Please enter all information clearly and double check for accuracy.

Name: _________________________________________     Date: ____/____/____
Shipping Address: (No PO boxes) __________________________________________
City: _____________________________________State: ______  Zip: __________
Phone # :( ____)________-____________  Fax : (____)________-_____________
Email: ___________________________________________
 
Quan.            ****** Product Description ******     Item #  Price Ea. **Total**
# * . $ $
# * . $ $
# * . $ $
# * . $ $
# * . $ $
# * . $ $
# * . $ $
If you need more room, please use a separate piece of paper.

                                                            Product Sub-Total ____________
                                               Sales Tax  (NC only: 6.75%) _____________
                                                   Shipping (from table below)  ___________
                                                                Total __________
Shipping Table
Sub-Total amount / Shipping cost
$.01-$30 / $8.89 <<>> $30.01-$50 / $10.95 <<>>$50.01-$75 / $15.00 <<>> $75.01-$99.99 / $20.00
$100-$199.99  / 14% of Sub-Total Amount   <<>>$200 - Up / 12% of Sub-Total Amount
Note:There will be higher shipping charges for Alaska, Hawaii,  and Truck Freight Items.
If using credit card; will email you total with shipping. If using check; please call 877-602-FIRE (3473) for totals.

Payment Method
Check / Money Order  # _____________ Make Checks Payable to:   Hart's Hearth Inc.

Credit Card    Visa ____   MasterCard ____ Discover______  American Express_____

Exact Name On Credit Card _____________________  Billing Address?__________________
                                                                                                     __________________________
Credit Card # _________________________________    Card Code_______  (on back of card)
Expiration Date __________       Signature ______________________________________
Fax to: 1-800-571-2765
Mail To: Hart's Hearth Orders,  2523 Middle Rd., Trenton, NC  28585