WOODSIDE VINEYARDS ONLINE ORDER FORM

Order Information:  Please read carefully as some states do not allow delivery.  To order, print this page and mail or fax to us at: (650) 851-5037.

Bill To:

Name:

____________________________________________ *

Address1:

____________________________________________  *

Address2:

____________________________________________  

City:

____________________________________________  *

State:

________  *                    Zip Code: _______________ *

Telephone:

____________________________________________  *

Fax:

____________________________________________  

Email:

____________________________________________  *

* Required Fields

Ship To:

__  Same As Billing

Name:

____________________________________________  

Address:

____________________________________________  

Address2:

____________________________________________  

City:

____________________________________________  

State:

_______                      Zip Code: _________

Telephone:

____________________________________________  

Fax:

____________________________________________  

Email:

____________________________________________  

Payment Information:

Card Number:

____________________________________________  

Name On Card:

____________________________________________  

Expiration Date:

______________ 

Special Information:

Laws in the states shipped require a date of birth to verify recipient he/she is over 21 years of age before completing any transaction. Additionally, recipient will be asked to show identification upon delivery.

Recipient date of birth:

___________ *

Comments Regarding Your Order:

We will contact you with the final cost of your order including shipping and taxes upon receipt.

THANK YOU FOR YOUR ORDER!