PRINTABLE ORDER FORM

YOUR NAME AND AGE

FIRST NAME:________________________________

LAST NAME: ________________________________

DATE OF BIRTH (MM/DD/YYYY): ______________________

YOUR SHIPPING ADDRESS (Signature Required by Recipient over the age of 21 to receive wines)

STREET: ____________________________________

CITY: _______________________________

STATE: _____

ZIP CODE: ____________________

PHONE NUMBER: _____________________

YOUR BILLING ADDRESS  (IF DIFFERENT)

STREET: ____________________________________

CITY: _______________________________

STATE: _____

ZIP CODE: ____________________

CREDIT CARD INFORMATION

NAME ON CARD: _______________________________

TYPE OF CARD: ______________________

CREDIT CARD NUMBER: _____________________________________

EXPIRATION DATE (MM/YY): _________________________________

SECURITY CODE: ________________

CARDHOLDER’S SIGNATURE: _____________________________________

ADDITIONAL COMMENTS:

MAIL TO:

21500 Shainsky Road

Sonoma, California 95476

FAX TO:

707-938-7597

Price List (Limited Inventory Quantities, First Come First Served, Prices Subject to Change without Notice):

Mt. Veeder Napa Valley Cabernet Sauvignon                                                  Quantity                                   .

2006 Mt. Veeder Cabernet Sauvignon: $125 ea.                                                  ________ x $125 = __________

2007 Mt. Veeder Cabernet Sauvignon: $200 ea.                                                  ________ x $200 = __________

2008 Mt. Veeder Cabernet Sauvignon: $200 ea.                                                  ________ x $200 = __________

St. Helena Napa Valley Cabernet Sauvignon

2006 St. Helena--Tittel Caloynnidis Cabernet Sauvignon: $85 ea.                       ________ x $ 85 = __________

2008 St. Helena--Tittel Caloynnidis Cabernet Sauvignon: $85 ea.                       ________ x $ 85 = __________

Oakville Merlot

2008 Oakville Merlot: $35 ea.                                                                                ________ x $ 35 = __________

Oakville Cabernet

2008 Oakville Cabernet: $ 55 ea.                                                                            ________ x $55 = __________

Napa Valley Chardonnay

2009 Oakville Villa Mille Rose Chardonnay: $45 ea.                                            ________ x $ 45= __________

2010 Ruhl Vineyard Yountville Chardonnay: $25 ea.                                            ________ x $ 25= __________

Vitners Reserve Wines

2005 Rutherford Napa Valley Cabernet Sauvignon: $60 ea                                    ________ x $ 60 = __________

2005 Napa Valley Cabernet Sauvignon: $29.95 ea                                                 ________ x $ 29.95 = _______

2005 North Coast Napa and Lake County Cabernet Sauvignon: $19.95 ea            ________ x $ 19.95 =  _______

                                                                                                                                 Total = ___________________

                                   

                                                                                                                                 Please Note: Veedercrest will

                                                                                                                                                       add sales tax and

                                                                                                                                                       shipping.