Facsimile Order Form

~ Minimum Order: Half-Case Please ~

Wines

Qty

Case Price

Qty

Bottle Price

2005   Jazz   ______       $312   ______       $26.00
2006   Jazz   ______       $312   ______       $26.00
2006   RRV Chardonnay   ______       $270   ______       $22.50
2005   Napa Valley Cabernet Sauvignon   ______       $480   ______       $40.00
2006   Napa Valley Petite Sirah   ______       $384   ______       $32.00
2006   Senal ~ Rockpile   ______       $360   ______       $30.00
2006   Rockpile Zinfandel   ______       $360   ______       $30.00
2006   Sonoma Coast Pinot Noir   ______       $456   ______       $38.00


Your Contact/Shipping Information ( * Required Info):

* First Name:________________________ * Last Name:________________________
* Address: ________________________________________________
* City: ________________________ * State: _________ * Zip: _________
    Phone: ________________________ Fax:________________________
* E-Mail: ________________________

Shipping Information (if different from above):

First Name:________________________ Last Name:________________________
Address: ________________________________________________
City: ________________________ State: __________ Zip: __________


We encourage all customers to ship to a business address in order to guarantee receipt!

Please fax form to: (707) 433-2506.

I will contact you with the details of your purchase and delivery charges.
Thank you!


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Branham Estate Wines ~ 1929 West Dry Creek Road, Healdsburg, CA 95448 ~ Phone (707) 738-0577