| 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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