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Order Form

We require that a person be over 21 years of age to sign for all shipments.  We highly recommend shipping to a business address as packages are normally delivered earlier in the day.

Please fill out the below billing and shipping information to help us expedite your purchase.

Billing Information
Birth Date: *	Company:
First Name: *	Last Name: *
Address: *	Address2:
City: *	State: * AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVTWAWIWVWY
Zip Code: *	Please Note: We cannot ship wine to a post office box.
Email: *	Phone: *
Our Wines: Sauvignon Blanc Cabernet Sauvignon Sauvignon Blanc
Shipping Address Same As Billing
Shipping Information
Birth Date: *	Company:
First Name: *	Last Name: *
Address: *	Address2:
City: *	State: * AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVTWAWIWVWY
Zip Code: *	Please Note: We cannot ship wine to a post office box.
Email: *	Phone: *
Please input the text from security hint below:
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Thanks again for your interest and if you would like to speak with an associate immediately please contact us at 707-255-8700