ORDER FORM

ORDER FORM! ORDER FORM! 2010 HARVEST
Mail, FAX, or Bring in now!

(NO E-MAIL ORDERS) (NO PHONE ORDERS!)

To: The Home Wine/Beer/Cheesemaking Shop

22836-2 Ventura Blvd. Woodland Hills, Ca. 91364

(FAX: 818-224-3812) (Phone: 800-559-9922)

(Sorry, no e-mail or phone ordering.)

PRINT CLEARLY

       VARIETAL              QUANTITY           $/Lb or Gal.        $ AMOUNT

_____________________     _____________           __________          ____________

_____________________     _____________           __________          ____________

_____________________     _____________           __________          ____________

_____________________     _____________           __________          ____________

_____________________     _____________           __________          ____________

NAME ______________________________________

ADDRESS ____________________________      GRAND TOTALS $____________

_____________________________ ZIP___________

                                                  (-) QUANTITY DISCOUNT   $____________

E-MAIL ADDRESS: _________________________________________

DAY PHONE ( )-___________________ SUBTOTAL $____________

CELL PHONE (        )-___________________

EVENING PHONE (        )-___________________

I'll be out-of-town from _________________    (-) 50% DEPOSIT $____________

My back-up is __________________________ Phone ________________

                       AMOUNT OF CHECK or CHARGE ENCLOSED $____________

Visa/MC/Disc/AMEX # _________________________________________________

Signature _______________________________ Expiration date _______________