[Add
7.25% Sales Tax for pick-up in or shipment to California]
Sales
Tax
$
Shipping
$
Total
Due
$
You
must be 21 years old to order and we may only ship wine to persons over
the age of 21. We will ship via UPS and require and adult signature before
delivery. We ship to most states. Please contact us by phone or email for
a list.
Full
Name:
Address:
City
and State:
Zip
Code:
Daytime
Phone:
Home
Phone:
Fax:
:
Please
take a moment to make sure you are filling in the following field correctly!
An E-mail address takes the form: name@domain.ext
E-mail:
[click
one]
Visa Mastercard
If
you are sending this form by the Internet or Faxing it, please fill out
the following credit card information:
Card
Expiration Date:
Name
as appears on Card:
Credit
Card Number:
Ship
the wine to the address above I
want the wine shipped to:
Ship
to Name:
Business
Name:
Shipping
Address:
Shipping
City and State:
Shipping
Zip Code:
Phone
for Shipping Inquiries:
Special
Instructions:
WANT
TO FAX OR MAIL INSTEAD?
If
you wish to FAX or MAIL this form, instead of using the Internet, feel
free to do so. You may fill out this form with your computer and print
it out or print it out and fill it in. Then fax or mail it, to the number/address
below. Also, many computers with fax modems will allow you to fill the
form out on-screen then fax it directly from your computer. Checks are
happily accepted instead of credit cards.
*Please
note: all prices are subject to change without notice.
