Messina Family Vineyards - Wine Order Form

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To ORDER ONLINE and pay by credit card, simply fill out the form below and submit.

Or, when using check or money order, complete this form and send payment made payable to: Messina Family Vineyards,
P.O. Box 1477
Healdsburg CA
95448-1477

You may also fax your order form to 707-433-1209 or call 707-433-3796 to place your order by phone.

PLEASE NOTE that we can currently only ship to the following states: California, Colorado, Idaho, Illinois, Iowa, Minnesota, Missouri, Nebraska, New Mexico, Oregon, Washington, West Virginia and Wisconsin.

Order 2002 Merlot, Dry Creek Valley

ORDER QUANTITY* and ship to STATE** are required

Item

Price per Bottle

ORDER QUANTITY*

Totals

Merlot, 2002

$18

Packing & Shipping

Within California

1 � 6 bottles $17.00

7 � 12 bottles $22.00

Outside California

1 � 6 bottles $30.00

7 � 12 bottles $40.00

Packing & Shipping

- 10% case discount

Sub Total

Shipments within California: Add 7.75% Sales Tax

Total $

Billing Information
First Name		Last Name
Billing Address
City		State	Zip
Telephone	-- (Daytime)	Telephone	-- (Evening)
E-mail Address
Shipping Information same as billing (Note - If making online payment and shipping to a different address, only Ship To state is required)
First Name		Last Name
Shipping/Street Address	Street Address required (we are unable to ship to PO Boxes)
City		STATE**	Zip
Telephone	-- (Daytime)	Telephone	-- (Evening)

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