Hearthworks
Attn: Shelley Stevenson
N7916 Pigeon Road
Sherwood, WI 54169-9798
Phone: (920) 284-0332
www.hearthworks.com
Email:shelley@hearthworks.com
www.hearthworks.com
Email:shelley@hearthworks.com
| Bill
To: Name _______________________________ Organization _________________________ Address _____________________________ City _______________________ State ____ Zipcode _______________ Phone Number (____) __________________ Fax (____) ___________________________ |
| Ship
To: [ ] same
as Bill To Name ________________________________ Organization __________________________ Address ______________________________ City _______________________ State ____ Zipcode _______________ Phone Number (____) __________________ Email _______________________________ |
|
Payment
Method
|
|
|---|---|
| [ ] | Check enclosed (payable to Hearthworks) |
| [ ] | Please
bill me (net 30 days) (available on orders of 25 or more) |
|
|
|
| Items Ordered | |
|---|---|
|
Description
|
Quantity
|
| My NICU Journal - Pink | |
| My NICU Journal - Blue | |
| My NICU Journal - Green | |
| My NICU Journal - Yellow | |
|
Total
Quantity
|
|
|
Unit
Price (see chart)
|
X |
|
Subtotal
|
$ |
|
WI
residents please add sales tax
|
$ |
|
Shipping
and Handling (see chart)
|
$ |
|
TOTAL
|
$ |
|
Unit
Price
|
|
|---|---|
|
$9.95
each
|
|
|
Call
for orders
of quantity
|
|
Shipping
Charges |
|
|---|---|
|
If
your quantity is: |
Your
Shipping and Handling charge is: |
|
1 or 2 |
$4.25 |
|
>
2 |
email us |
All orders are shipped USPS.
