FAX-BACK ORDER FORM

Fax-Back Order Form
(a) fax back with your credit card information to (478) 477-6535.
(b) print out and mail with your check or credit card information to:
Hearthstone, Inc.,  Attn. John Ricketson
120 Carriage Drive, Macon, GA  31210 
(877)  662-6135
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______     $201-250K______     $251-300K______     $301-350K++_______
Building Site Location ________________________(County) ________________(State)
Square Footage Desired:____________            1Story_____     1 1/2 story _____     2Story _____
Primary Interest:  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.)
Print name as it appears on card:____________________________________________

Signature: ________________________________________________________________
Description Price Total
Log & Timber Frame Homes by Tina Skinner $35.00      $
Catalogue $10.00      $
Multi-Media CD-ROM  $10.00      $
Catalogue & CD-ROM Set $15.00      $
Timber Frame Portfolio $8.00      $
Shipping & Handling $5.00      $
  TOTAL      $

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