Please complete this form entirely. Once sent, we will hand-process your order, adding appropriate shipping and tax, charge your credit card and contact you with a confirmation. All information is kept strictly confidential.
You may also print this form and fax in your order or order via telephone at 707.647.3388.
Wine Society - 6 btls. once a yr. (save 25% off retail price)
Varies
Qty.
Buyer's Billing Info:
First Name:
Last Name:
Street Address:
Street Address line 2:
City:
State:
ZIP
Tel:
Email:
I certify that I am over 21 years old.
Shipping Info: (leave blank if same)
First Name:
Last Name
Business Name:
Street Address:
Street Address line 2:
City:
State:
ZIP
Tel:
I certify that the recipient is over 21 years old.
YOUR INFORMATION IS SECURE & PRIVATE.
Please charge to: Visa MasterCard AMEX
Card #:Exp. (mm/yy):
3 or 4 Digit Number on Back of Card
For your convenience, we calculate discounts, tax & shipping at the winery. You will receive a confirmation email with charges & tracking number.
Any Additional Comments:
By submitting this form you will not hold J.Moss Wine responsible for any damages as a result of this communication. You allow J.Moss Wine to charge your credit card. You agree that buyers and recipients are 21 years or older. We do not offer any refunds, credits and cannot accept returns. Please no exceptions.
