Wine 1                          Qty           Package

Choose A Wine Cabernet Franc 2000 Chardonnay 2001 Rapture 2004 Riesling 2005        Choose Package Bottle(s) Case(s)

Wine 2                          Qty           Package

Choose A Wine Cabernet Franc 2000 Chardonnay 2001 Rapture 2004 Riesling 2005        Bottle(s) Choose Package Case(s)

Wine 3                          Qty           Package

Choose A Wine Cabernet Franc 2000 Chardonnay 2001 Rapture 2004 Riesling 2005        Bottle(s) Choose package Case(s)

Wine 4                          Qty           Package

Choose A Wine Cabernet Franc 2000 Chardonnay 2001 Rapture 2004 Riesling 2005        Bottle(s) Choose package Case(s)

Name

Address

City                                   State*                    Zip

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*We cannot ship directly to consumers in many states because the state does not allow it or the state requires costly permits and paperwork that do not allow for small shipments.  When we follow up to complete your order, we will let you know if we can ship to your state.

Phone (555-555-1212)

Email

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