Home Page Heart of the Earth Order Form (Complete the form & print it)

Fax: (605) 892-0154

Mailing Address:

Heart of the Earth Market 205 High St. Fruitdale, SD 57742

Telephone number required, this is used for credit card processing and delivery information only!

Item No.	Description	Qty	Unit Price	Total
Sub Total:
Tax (South Dakota Residents Only add 6%):
Shipping - If you do not know the shipping, we will figure it:
If you would you like Postal Insurance, add $1.00:
Grand Total:

Your Name
Street Address
Mailing Address
City
State
Zip Code
Country
E-mail Address
Telephone No.
Credit Card	VISA MASTER CARD AMERICAN EXPRESS
Name on Credit Card
Credit Card Number
Expiration Date (on card)
Signature

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