Washington Street Purveyors

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Copy and paste you order to mailto:csmith@gopherwine.com?subject=WINE ORDER (or phone 888-678-9463). You will receive confirmation within 24 hours. **If you do not receive confirmation, please call 888-678-9463.**

Case orders receive 10% discount unless price is NET. All bottles contribute to case quantity.

If transmitting credit card information via this form makes you queasy, still submit your order and then phone with your card information.

Repeat customers need only enter their name.

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Day Phone
E-mail
Business/Residential?	(important)
Organization

CC# Billing Address
City
State/Province
Zip/Postal Code
(Card billing information is requested for Card Verification and reduces costs by preventing Credit Card Fraud
Ship Date
Ship Speed

	BILLING ADDRESS (if different than shipping...)
Credit Card #
Expiration

QTY	DESCRIPTION