Coffee Order Form

Each 12 ounce bag can be yours for just $10, and 100% of the profits ($3.50 per bag) will go to Heartland Farm Sanctuary and its animals. You can purchase a bag for yourself or a friend, or you can buy in bulk and sell Heartland Coffee as a fundraiser to help our animals and the vulnerable youth they serve.

Please fill out the online form below and click the 'Submit' button at the bottom of the page, or download the Printable Coffee Order Form (PDF)* and mail the completed form to HFS, PO Box 45746, Madison, WI 53744
* To view and print PDF files, you must download and install Adobe Acrobat Reader.

Customer Information
* Your Name:
* Address:
* City, State Zip: ,
* Phone Number:
* E-mail:
Note: E-mail is our preferred method of contact. Our e-mail may be blocked by your filters; please check your junk e-mail folders if you have not received an e-mail from us confirming receipt of your application.
Order Information
Coffee Type Number of Bags Price per Bag Cost
Clark's Dark - Just Coffee’s Dark Bolivian Blend $10.00 $
Good Morning Maxine! - Just Coffee’s Medium Nicaraguan Roast $10.00 $
Calculate your total:
Total: $
Payment Information
We will call or email you to collect your payment and arrange for delivery or pick-up.
Additional Comments and/or Questions:
To complete this form, click the 'Submit' button bellow.