The Heartland USA Gallery Rural Collectibles Lithodgraphs & Limited Editions

Please print this form, fill it out completely, and mail or fax it to Heartland U.S.A., 25028 South LaGrange Road,Monee, IL 60449; Fax (815) 469-3741. We also accept payment via the PayPal system. Email: brooksfarmart@msn.com

Name:
Address:
City, State, Zip:
Phone (day):
Phone (night):
E-mail Address:
Item#: Description: Qty: Price
Each:		 Total
Price:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Minimum Order =$15.00

 

 

 
Method of Payment:
(U.S. Funds Only-Foreign Orders Add $12.00 per item.)

Check / Money Order
Visa MastercardDiscover
All prices in catalog include shipping and handling.

Credit Card Number: Expiration Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V Code (Last 3 Digits on Back of Card) :

 

 

 

Your signature, as it appears on your credit card.

Subtotal

Shipping and Handling

$0.00

Total

Sales Tax (In Illinois 6.5%)

Total Due

After you have printed this form, please click here to return to our site.

HEARTLAND USA

Phone (815) 469-1041

All prices include
shipping & handling

Fax (815) 469-3741