Click here to go back to Home page.

Majestic Heartland Order Form
(Print and Fax to : 815-547-8908 or send to: 8611 Huber Rd. Belvidere, IL 61008)
Make checks & money orders payable to: Majestic Heartland

Credit Card information taken at bottom of form

Name__________________________________Address________________________________

______________________________________________________________________________
Phone (must include area code) (         )              -________________

 Section 1-Goat Milk Originals Soaps-$5.00 ea., Aromatherapy & Herbal Soaps $5.25 ea.
     FRAGRANCE               STYLE        QTY                PRICE

1.________________________________________________

2.________________________________________________

3.________________________________________________

4.________________________________________________
          Section 1                          SUBTOTAL___________

Section 2-Goat Milk Originals Lotions-$8.75 ea., Aromatherapy Lotion $9.75 ea.
          FRAGRANCE          SIZE    QTY           PRICE

1._______________________________________________

2._______________________________________________

3._______________________________________________

4._______________________________________________

          Section 2                         SUBTOTAL___________

Section 3-Goat Milk Originals Bath Salts-$5.50 ea., Aromatherapy Salts $8.00 ea.
         FRAGRANCE                 QTY               PRICE

1.________________________________________________

2.________________________________________________

3.________________________________________________

4.________________________________________________

          Section 3                          SUBTOTAL_____________

Section 4-Goat Milk Guest Soaps-Oval Rose-$1.75 & $3.00 ea.
     FRAGRANCE               SIZE           QTY            PRICE

1.________________________________________________________

2.________________________________________________________

3.________________________________________________________

4.________________________________________________________                         

          Section 4                                         SUBTOTAL_____________

Text Box: Shipping Charges: Less than $20.00-add $8.00 $21.-$40.-$9.00 $41.-$60.-$10.00 $61.-$80.-$11.00 $81.-$100.-$13.00 Over $100.-$16.00 Section 5-For My Feet-
     DESCRIPTION              SIZE           QTY            PRICE

1.________________________________________________________

2.________________________________________________________

3.________________________________________________________

4.________________________________________________________                         

          Section 5                                         SUBTOTAL_____________

Section 6-Other Supplies-
          DESCRIPTION            SIZE              QTY                 PRICE

1.______________________________________________________

2.______________________________________________________

3.______________________________________________________

4.______________________________________________________                         

        Section 6                                        SUBTOTAL_____________

SUBTOTAL (Sections 1-6)______________

S&H (See Right)________________                                  DATE:________________

TOTAL ENCLOSED _______________

Type of Card:______________________________

Credit Card #                                                           

Exp. Date:_______________________________

Name on Credit Card:__________________________________

Signature:_______________________________________________

Type of Business:_________________________________________

Back to Top