| CONTACT INFORMATION | |||
|---|---|---|---|
| Name |  |
Phone | |
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Fax | ||
1. PRINT OUT THIS PAGE & FILL OUT
2. FAX ORDER TO: (707) 257-7001
|
Directions: 1. PRINT OUT THIS PAGE & FILL OUT 2. FAX ORDER TO: (707) 257-7001 |
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| SHIP TO: | |
BILL TO: | |
| Name | |
Name | |
| Address | |
Address | |
| Address | |
Address | |
| City, ST. Zip | |
City, ST. Zip | |
| Phone | |
Phone |
| Payment type | Credit Card Number | Exp. |
| MC / VISA / DISCOVER | |
| Ship Method | Ship Date |
| Overnight / 2nd Day / 3 Day / Ground / Saturday | |
| Qty. | Code | Item Description | Unit Price |
Total |
|
2005 Perata Vineyards Cabernet Sauvignon "Frank's Blend"
|
$20.00 | ||
|
2003 Perata Vineyards Cabernet Sauvignon |
$39.00 | ||
|
2004 Perata Vineyards Cabernet Sauvignon |
$39.00 | ||
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| Gift Message/Special Instruction | Subtotal | |||
| 10% Case discount | ||||
| Tax | ||||
| Freight | ||||
| Total | ||||