Fax-Back Order Form |
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Name*____________________________________________ *Required Fields Before Order Processing | |
Address*__________________________________________ | |
Address*__________________________________________ | |
City*__________________________________ State*____________ | |
Zip Code*_______________________ | |
Home Phone* _____________________ Work Phone*_____________________ | |
E-mail Address:________________________________________________________ | |
How did you hear about Hearthstone?_________________________________________________ | |
Budget: $150-200K______ (small cabin) $201-250K______ $251-300K______ $301-350K_______ $350K+ ___________ | |
Building Site Location ________________________(County) ________________(State) | |
Square Footage Desired:____________ 1Story_____ 1 1/2 story _____ 2Story _____ | |
Primary Interest: (choose one) Log _____ TimberFrame _____ Barn _____ Log/TF Hybrid _____ | |
When do you plan to begin building? _________________(Mo.) _______________(Yr.) | |
Check Method Of Payment: ____MasterCard ____VISA ____AMEX | |
____Check (Make checks payable to Hearthstone, Inc.) | |
Card No.:_______________________________________ Exp. Date:___________________ CVV#_________________ | |
(The CVV number is the last 3 numbers in the security line on the back of your card.) |
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Print name
as it appears on card:____________________________________________ Signature: ________________________________________________________________ |
Description | Price | Total |
Log & Timber Frame Homes -or- Log Cabins, Past & Present (choose one) | $25.00 | $ |
Catalogue | $10.00 | $ |
Multi-Media CD-ROM (out of print) | N/A | $ |
Commercial Projects Portfolio | $10.00 | $ |
Timber Frame Portfolio | $8.00 | $ |
Shipping & Handling (per order, not per catalog or book) | $5.00 | $5.00 |
TOTAL | $ |