Heartland Telegram Order Form

TELEGRAM ORDER FORM

HEARTLAND SENDING OFFICE
Sender's Name
Sender's Email
example@example.com
Recipient's Full Name
Recipient's Country
Recipient's Full Address
street, city, state/region, postal code
Your Message
Keep it short and sweet — 50 words approx.
Anything Else?
Product Gallery

Select a Message Type

Telegram

Sent Domestically

$10.00

Cablegram

Sent Internationally

$15.00

Domestic Radiogram

$10.00

International Radiogram

$15.00

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty: