Please provide the following billing information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
E-mail

Please provide the following shipping information:

Name
Street Address	(NO P.O. Boxes Please)
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
E-mail

This order form is used to purchase the following product:

Complete Winemaking Kit @ $149.95 incl. S&H Wine Recipe Only @ $59.95 per recipe (includes S&H)

Please select a wine recipe to accompany your winemaking kit:  

Chardonnay - Rich, mellow & golden. Hints of apple Cabernet Sauvignon - Classic dry red Merlot - Soft, rich, early maturing dry red Blush - Light & fruity, slight blackberry tones Chablis - Crisp, pale white, lemon and citrus aroma Gewurztraminer - Spicy dry white Liebfraumilch - Smooth dry white Sauvignon Blanc - Delicate, herbaceous dry white White Bordeaux - Bone dry white White Burgundy - Soft & fruity Rhine Riesling - Crisp & fruity dry white Red Burgundy - Soft, dry and spicy Bergamais - fruity, light, dry red. Chianti - Fruity Italian red Pinot Noir - Polished red wine with oak flavor Red Bordeaux - Delicate light red with a hint of oak   (RECIPE #1)

An additional wine recipe may be purchased for $49.95 and included with your winemaking kit at no extra shipping charge. If you would like to add an additional recipe to this order, please select one below:

No additional recipes please. Chardonnay - Rich, mellow & golden. Hints of apple Cabernet Sauvignon - Classic dry red Merlot - Soft, rich, early maturing dry red Blush - Light & fruity, slight blackberry tones Chablis - Crisp, pale white, lemon and citrus aroma Gewurztraminer - Spicy dry white Liebfraumilch - Smooth dry white Sauvignon Blanc - Delicate, herbaceous dry white White Bordeaux - Bone dry white White Burgundy - Soft & fruity Rhine Riesling - Crisp & fruity dry white Red Burgundy - Soft, dry and spicy Bergamais - fruity, light, dry red. Chianti - Fruity Italian red Pinot Noir - Polished red wine with oak flavor Red Bordeaux - Delicate light red with a hint of oak   (RECIPE #2)

In which month would you like your winemaking kit to ship:

January February March April May June July August September October November December

If you're placing a gift order, please type your gift message below:

Please select one of the following gift message placement options: (35 char. per line - 5 line max.)

Enclose with winemaking kit. Send gift message immediately to recipient. Send gift message immediately to me.

Please provide your credit card information:

	BILLING
Credit Card	VISA MasterCard American Express Discover
Cardholder Name
Card Number
Expiration Date