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FranksWine Sampler Pack Order 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. Receipts will be sent to this address.
*E-Mail:
Sampler Pack Information
Sampler Pack Name
Confirm Total # Bottles
Confirm Cost
Quantity Packs Desired
Your Information (fill out completely if ordering)
*Your Date of BirthYou must be 21 or older
*First Name:Same name as on your card
Middle Initial:
*Last Name:
*Address Line 1:
Address Line 2:Apt. or Suite No.
*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
Comments
Frank will personally get back to you within 24 hours!
NOTICE: You must be 21 years of age to purchase alcoholic beverages. Ordering confirms you are at least 21.
For first time online orders: please fax a copy of your drivers license (front and back) to 302-429-8962`` for age verification.``

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