BlueNoseOrderForm

Bluenose Wines

Order Form

2005 Zinfandel $25.00		=
Other Varietals
2005 Sonoma County Syrah $25.00		=
	Total	=

Shipping and tax will be added if applicable. I certify that I am 21 years of age or older. If payment is by credit card, I give permission to Bluenose to charge my credit card for each shipment.

Name
Company
Street Address
City/State/Zip
Phone
Email

Payment Method

I am enclosing a check payable to Brasset Cellars| 2031 Madrone Ave | Healdsburg, CA 95448

I am paying by credit card with my | Expiration date: /Card Number

Other method:________________________________________________________

Shipping Address Shipping address is the same as Billing Address.

We strongly suggest shipping to a business address. Adult signature is required for wine delivery.

Name
Company
Street Address
City/State/Zip
Phone

Mail or fax this form with enclosed payment information to:

Bluenose Wines | 2031 Madrone Ave | Healdsburg, CA 95448 | Phone/fax: 707-433-5129 |Questions? Call 707-433-5129 or email Paul Brasset at paul@bluenosewines.com