PAYMENT METHOD: (check one): CHECK _______ MONEY ORDER _______
CARD NUMBER: EXP. DATE
OLD SOUTH WINERY
65 South Concord - Natchez, MS 39120
601.445.9924 601.442.1215, fax
mailus@newu.netPayment by check accepted from within the United States only.
Use the form below.DIRECTIONS: Print out the form. Circle the quantity of bottles you wish to order, then complete the address section before mailing or faxing the form to us. PRINTER FRIENDLY VERSION
QUANTITY
PRICE SHIPPING/ HANDLING TOTAL COST - U.S. $ 1 $ 16.00 $ 3.00 $ 19.00 2 $ 32.00 $ 4.00 $ 36.00 3 $ 48.00 $ 4.00 $ 52.00 4 $ 64.00 $ 6.00 $ 70.00 6 $ 96.00 $ 8.00 $ 104.00 8 $ 128.00 $ 9.00 $ 137.00 12
$ 192.00 FREE ! $ 192.00
NAME
ADDRESS
CITY STATE ZIP
PHONE E-MAIL
PAYMENT METHOD: (check one): CHECK _______ MONEY ORDER _______
CARD NUMBER: EXP. DATE