Order Form
You may either print this order form and mail it, or save and print the .pdf printer-friendly version and mail it or fax it. We are only allowed to ship to the following states: Alabama, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Illinois, Louisiana, Maine, Maryland, Michigan, Mississippi, Minnesota, Missouri, Montana, North Carolina, North Dakota, Nebraska, New Mexico, New York, Nevada, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Utah, Washington, Wisconsin, West Virginia, Washington DC and Wyoming.
| NAME | ||
| ADDRESS | ||
| CITY | STATE | ZIP |
| PHONE NUMBER | FAX | |
| My signature certifies that I am (21) twenty one years old. |
Signature (Required)
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| We accept: (circle) Checks, Money Order, and Credit Cards (Discover, Visa and MasterCard) | Credit Card Number: | Expiration Date of Card: | |||||||
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SIGNATURE
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Wines
|
Quantity
|
Per Bottle
All bottles 750ml, except where noted |
|
Quantity
|
Per Case
|
|
Sub Total
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TOTAL
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| WHITES | |||||||||
| |
OAK CHARDONEL | |
$12.99 | |
|
$155.88 | |
|
|
| VILLARD BLANC | |
$9.99 | |
|
$119.88 | |
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|
|
| CHARDONEL | $12.99 | $155.88 | |||||||
| VIDAL BLANC | |
$10.99 | |
|
$131.88 | |
|
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| TRAMINETTE | |
$11.99 | |
|
$143.88 | |
|
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| HEARTLAND WHITE | |
$9.99 | |
|
$119.88 | |
|
|
|
| VIGNOLES |
$12.99 | $155.88 | |||||||
| SHAWNEE GOLD | |
$12.99 | |
|
$155.88 | |
|
|
|
| WIENER DOG WHITE | $12.99 | $155.88 | |||||||
| RESERVE GOLD |
$14.99 |
$179.99 |
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| BLUSHES | |||||||||
| |
ALTO FESTA |
|
$11.99 | |
|
$143.88 | |
|
|
| HEARTLAND BLUSH | |
$9.99 | |
|
$119.88 | |
|
|
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| FRUIT WINES | |||||||||
| CHERRY | |
$9.99 | |
|
$119.88 | |
|
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| CHERRY BERRY |
$12.99 |
$155.88 |
|||||||
| PORT WINES | |||||||||
| |
HEARTLAND PORT | |
$9.99 | |
|
$119.88 | |
|
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| PORTO DI GUIDO |
|
$21.99 | |
|
$263.88 | |
|
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| REDS | |||||||||
| |
CHANCELLOR | |
$10.99 | |
|
$131.88 | |
|
|
| 2003 CHAMBOURCIN | |
$11.99 | |
|
$143.88 | |
|
|
|
| 2008 CHAMBOURCIN |
$24.99 | $299.88 | |||||||
| ROSSO CLASSICO | |
$14.99 | |
|
$179.88 | |
|
|
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| NORTON | |
$18.99 | |
|
$227.88 | |
|
|
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| DAWG HOUSE RED | $12.99 | $155.88 | |||||||
| ROCKO RED |
|
$12.99 | |
|
$155.88 | |
|
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| HEARTLAND RED | |
$9.99 | |
|
$119.88 | |
|
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| SANGRIA | |||||||||
| NONA MIA SANGRIA |
$9.99 |
$119.88 |
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| SUBTOTALS | |
| Subtract 10% of cost for orders of 12 or more bottles -OR- "Case Club Discount" | |
| ADD 7.5% Sales Tax | |
| Shipping & Handling: | (1) |
|
Illinois 2 bottles-($13.00) Illinois 4 bottles- ($18.50) Illinois 6 Bottles ($24.25) Illinois 12 Bottles (29.00) Out of State 2 Bottles (15.00) Out of State 4 Bottles (22.50) Out of State 6 Bottles (30.50) Out of State 12 Bottles (41.00) |
(2) |
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TOTAL
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You must be 21 years of age or older to purchase wine online. When receiving shipment identification will be required. We are only allowed to ship to the following states: Alabama, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Illinois, Louisiana, Maine, Maryland, Michigan, Mississippi, Minnesota, Missouri, Montana, North Carolina, North Dakota, Nebraska, New Mexico, New York, Nevada, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Utah, Washington, Wisconsin, West Virginia, Washington DC and Wyoming. |
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This list cancels all previous lists. Prices subject to change without notice. This list issued February 2012.