Country at Heart - Hand-Crafted Primitive Dolls and Animals

Country At Heart Retail Order Form

Ordering online from Country at Heart is very easy. We accept personal checks, money orders, Mastercard, Visa, Discover, and Paypal. Just fill out the form, print it out, and send it, along with your credit card number or check/money order (payable to Country at Heart) to:

Country at Heart
19347 Spinnaker Cir.
Strongsville, OH 44136

You can also place an order by phone. Just call Sandy at (440) 238-9192. Or, send an e-mail to sandy@hoerig.com and we will contact you.

Part 1: Customer Information

Name:
Address:
City:
State:	ZIP:
E-Mail:
Phone:

Part 2: Items

Qnty.	Item #	Item Description	Color (if applicable)	Total Cost
				$
				$
				$
				$
				$
				$
				$
			Merchandise Total	$
			Ohio Residents Add 7.75% Sales Tax	$
			TOTAL	$
Please note that all prices include shipping to the continental United States. Please contact us for shipping rates to all other areas.

Part 3: Payment
Credit Card Number:	(XXXX-XXXX-XXXX-XXXX)
Expiration Date:	(MM/YYYY)
Signature:	______________________________

Make sure all the information you entered is correct. Print out the completed form and send it with payment to the address at the top of the page.