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Product Order and Inquiry Form
Your E-Mail
NOTICE: You must be 21 years of age to purchase alcoholic beverages. Ordering confirms you are at least 21.
Important: Enter a valid e-mail address. Responses will be sent to this address.
*E-Mail:
Type in your Order or Request for Information ~ IGNORE if making a DEPOSIT or PAYMENT
VintageFill in as much as possible
Winery
Grape VarietalSelect a varietal or color
Appellation/Region
Shipper/Importer
Quantity DesiredIf Ordering
Comments
CARD HOLDER Information (fill out completely if ordering)
*Your Date of BirthYou must be 21 or older
*First Name:Use same name on card name
Middle Initial:Optional
*Last Name:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Phone:
Company Name:If applicable
Credit/Debit Card Information (fill out completely if ordering)
Card Number:No dashes or spaces please
Expiration Month:From your card
Expiration Year:From your card
Card Brand:
CVV2:Card Security Code
Frank will personally get back to you within 24 hours!
Additional Comments
For first time online orders: please fax a copy of your drivers license (front and back) to 302-429-8962` for age verification.`
NOTICE: You must be 21 years of age to purchase alcoholic beverages. Ordering confirms you are at least 21.

****THIS OFFER IS VOID WHEN AND WHERE PROHIBITED****
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