Serenading Grapes International Monthly Wine Club Fax Order Form

Winemaking Kit Order Form


Notes on how to use the form below :
Use the TAB key to move from one field to another, or just use your mouse to click in the appropriate field.
The RETURN key will submit the form to the "Form Confirmation" screen.
To edit your submission from the "Form Confirmation" screen, select the "Back" button on your browser and continue.

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:


Please select a wine recipe to accompany your winemaking kit:  

  (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:

  (RECIPE #2)

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


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.)


Please provide your credit card information:

BILLING
Credit Card
Cardholder Name
Card Number
Expiration Date

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Serenading Grapes is a division of World Beer Direct, Inc.