| 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: AR, CA, CO, DC, GA, HI, IA, ID, IL, LA, MN, MS, NC, ND, NE, NM, OR, SC, TX, VA, WA, WI, WV and WY. | |
| wine | price per bottle by the... | qty. | total $ | ||
|---|---|---|---|---|---|
| bottle | 1/2 case | case | |||
| Cupola American Semi-Dry White wine | $8.75 ea. | 8.50 ea. | 8.25 ea. | ||
| Badger Blush American Semi-Dry Red wine | $8.75 ea. | 8.50 ea. | 8.25 ea. | ||
| Big Stuff Red Wisconsin Semi-Dry Red wine | $9.25 ea. | 9.00 ea. | 8.75 ea. | ||
| Big Stuff Too! American Semi-Dry White wine | $9.00 ea. | 8.75 ea. | 8.50 ea. | ||
| Finis American Sweet Dessert White wine | $9.00 ea. | 8.75 ea. | 8.50 ea. | ||
| Botham Vineyards Gift Certific wine | $0.00 ea. | 0.00 ea. | 0.00 ea. | ||
| Riesling American Semi-Dry White wine | $9.50 ea. | 9.25 ea. | 9.00 ea. | ||
| Seyval Blanc American Dry White wine | $8.75 ea. | 8.50 ea. | 8.25 ea. | ||
| 2008 Uplands Reserve Wisconsin Dry Red wine | $10.00 ea. | 9.75 ea. | 9.50 ea. | ||
| Vin 10 American Semi-Dry White wine | $9.00 ea. | 8.75 ea. | 8.50 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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