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					                        CLOS DE LA TECH 2001 VINTAGE ORDER FORM



Mailing Address (please make any necessary changes)                              Shipping Address (please fill out each time to avoid error)

Name:                                                                                Same as Mailing Address

Company:                                                                         Name: ______________________________________________

Street:                                                                          Company: ___________________________________________

City/State/Zip:                                                                  Street: ______________________________________________

Telephone:                                                                       City/State/Zip: ________________________________________

Fax:                                                                             Telephone: __________________________________________

E-mail: _________________________________________
                                                                                 We recommend you list an address where someone can accept
                                                                                 the shipment; we cannot be held responsible for stolen wine.




     Your                            Wine Description                             Price Per      Bottles           Total Cost              Additional
  Allocation       The wine is very limited (110 cases). Orders will be filled     Bottle        Ordered                                    Bottles
                              on a first-come first-served basis.                                                                          Requested

                  2001 Domaine du Docteur Rodgers Pinot Noir                       $101.50

                        Shipping and Handling costs for California: $4.00 per bottle ($14.00 min.)                                       Shipping
                                                                                                                                         Subtotal
                                                                           California Sales Tax is 8.25%                                 Sales Tax
                                                                                                                                         Total




Payment Method (circle one):            Visa       Master Card          Check Enclosed (payable to Clos de la Tech, LLC)

Credit Card Number: _______________________________________________________ Expiration Date: _____________________

Name as is appears on the credit card: _________________________________ Signature: _________________________________

____ My credit card billing address is different than the mailing address indicated, it is (write below):

__________________________________________________________________________________________________________

Order by fax:       650-298-8137

Order by phone: 650-722-3038

Order by email: vm@cypress.com

Order by Mail:      P.O. Box 370, Sonoma, CA 95476



Please read and sign: Wines may be sold and delivered only to persons who are at least 21 years old. In placing your order, you represent to us that you
are at least 21 years old and that the person to whom delivery will be made is at least 21 years old.

Signed: ____________________________________________________                                  Date: ____________________________

				
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posted:5/30/2010
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