PURCHASE REQUEST: This form is a request to purchase your selected wines. There is a minimum purchase of $195 to qualify to have your wines shipped. When you send this request, Jay will verify the purchase, and follow-up with the digital invoice for payment, or will communicate with any clarification.

Name

First Name

Last Name

Phone

(###)

###

####

Shipping Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Shipping / Pickup Request

Ship UPS/FedEx Ground

Ship Expedited UPS/FedEx

Pick-up at the Winery ASAP

Pick-up at the Winery at a later date

Additional Info / Special Requests

Is there anything else you would like us to know?

Consent

By submitting this form, I am confirming that I am of legal drinking age.

Yes, I'm of legal drinking age.

Purchase

EIEIO & COMPANY