To order by fax, print this form, fill out your order and fax it to 608-924-3310. Thank you!

Bill to:

Name_________________________________

Address______________________________

City_______________________State_____

Zip_______________Phone (___)________

Ship to*:

Name_________________________________

Address______________________________

City_______________________State_____

Zip_______________Phone (___)________

* Regulations prohibit us from shipping wine to any state except the following: AK, AR, AZ, CA, CO, CT, DC, FL, GA, HI, IA, ID, IL, IN, KS, LA, M0, MD, ME, MI, MN, NC, ND, NE, NH, NM, NV, NY, OH, OR, SC, TN, TX, VA, VT, WA, WI, WV and WY.
wine price per bottle by the... qty. total $
bottle 1/2 case case
8180
American Dry Red wine
$16.00 ea.16.00 ea.16.00 ea.  
Badger Blush
American Semi-Dry Red wine
$9.00 ea.8.75 ea.8.50 ea.  
2011 Big Stuff Red
Wisconsin Semi-Dry Red wine
$10.50 ea.10.25 ea.10.00 ea.  
Cupola
American Semi-Dry White wine
$9.00 ea.8.75 ea.8.50 ea.  
2011 Field 3
Wisconsin Dry Red wine
$18.00 ea.18.00 ea.18.00 ea.  
Finis
American Sweet Dessert White wine
$9.00 ea.8.75 ea.8.50 ea.  
Latitude 43
American Dry White wine
$12.00 ea.11.75 ea.11.50 ea.  
Riesling
American Semi-Dry White wine
$10.50 ea.10.25 ea.10.00 ea.  
2010 Uplands Reserve
Wisconsin Dry Red wine
$11.00 ea.10.75 ea.10.50 ea.  
Vin 10
American Semi-Dry White wine
$10.00 ea.9.75 ea.9.50 ea.  
total number of bottles:  
subtotal:  
WI residents add 5.5% sales tax:  
total:  
Payment:

[ ] Visa [ ] Mastercard [ ] Discover

(check one)

Credit Card Number:

_______________________________________

Expiration date:_____/______

Signature (required):

(X)____________________________________

I certify that I am at least 21 years of age.

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