By checking this box you represent to us that you are at
least 21 years old and that the person to whom
you are directing delivery is at least 21 years old.
|
Bethel Heights Vineyard |
Wine Order Form |
June 2008 |
| 6060 Bethel Heights Road NW - Salem, OR 97304 - Phone (503) 581-2262 - Fax (503) 581-0943 - www.bethelheights.com | ||
| Ordered by: | Ship to:(if different from Ordered by): |
| Name:_____________________________ | Name:_____________________________ |
| Address: ___________________________ | Address: ___________________________ |
| __________________________________ | __________________________________ |
| __________________________________ | __________________________________ |
| Telephone:__________________________ | Telephone:__________________________ |
| Fax:_______________________________ | Fax:_______________________________ |
| Email:_____________________________ | Email:_____________________________ |
| Quantity | Bottle Price | Total | |
| 2007 Pinot Blanc | $16.00 | ||
| 2007 Pinot Gris | $16.00 | ||
| 2006 Chardonnay Quercus Non | $18.00 | ||
| 2005 Chardonnay Estate Grown | $25.00 | ||
| 2006 Chardonnay Estate Grown | $25.00 | ||
| 2006 Pinot Noir Eola-Amity Hills Cuveé | $30.00 | ||
| 2006 Pinot Noir Jessie James Vineyard | $50.00 | ||
| 2006 Pinot Noir Seven Springs Vineyard | $50.00 | ||
| 2006 Pinot Noir Casteel Reserve | $60.00 |
| Total Bottles:______________ | Subtotal wine_______________ |
| Discount 17% for 12 bottles or more_______________ | |
| Packaging & Shipping (see chart below*) _______________ | |
| TOTAL _______________ | |
| Phone/Fax Order
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Mail Order
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| Payment Method: | Credit Card
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Check
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By checking this box you represent to us that you are at
least 21 years old and that the person to whom
you are directing delivery is at least 21 years old.
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| Credit Card Signature:______________________________ | |||
| Credit Card Number: _______________________________ | |||
| Expiration Date:_______________ | |||
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