|
I
am Buon a Amici Wine Club Member |
Last
Name:
|
|
First
Name
|
|
|
I
certify that I am 21 years of age or older |
Address: |
|
City: |
|
State:
|
|
Zip
Code: |
|
Daytime
Phone: |
|
Home
Phone: |
|
E-mail: |
|
[click
one] |
Visa Mastercard American
Express
Discover
|
Card
Expiration
Date: |
Month
Year
|
Name on
Card: |
|
Credit
Card Number: |
|
Card Code |
|
|
This is a gift and I would like to include a
note in the box |
|
Enter your gift text
here:
|
|
IF YOU
WOULD LIKE TO PICK UP YOUR WINE, PLEASE FOLLOW THESE STEPS:
- Fill out the Ship the wine to section below
(for our records).
- In the special instructions box below, tell
us you want to pick up you wine.
- Make an appointment to pick up your wine here:
Book an Appointment
Use
the button to copy available address information from above, if you
like.
Note: We can only ship to certain states.
Ship
the wine to:
|
|
|
Ship to
Last
Name: |
|
Ship to
First Name:
|
|
Business
Name: |
|
Ship To
Address: |
|
Ship To
City: |
|
Ship To
State:
|
|
Ship To
Zip
Code: |
|
Ship To
Phone: |
|
Carrier:
|
No
Preference
Fedex
UPS
|