Hopkins Vineyard Printable Order Form

S.R.________________ Order Date________________ Date Shipped________________ Order Information Billing Address: Name Street City State Zip Phone, daytime Case = 12 Bottles. Cases can be mixed. Case purchasers should calculate appropriate discount based upon individual bottle prices before including shipping and tax. Please call the winery during business hours if you are unsure of your discount or need assistance in placing your order. Shipping Address: Leave blank if the same as billing address Name Street City State Zip Phone, daytime Gift Message Quantity Bottles Wine Variety Price per bottle Total See below for shipping information. Wine Total Shipping Subtotal CT residents add 6% Sales Tax Total Order           Shipping Within CT: 2-pack $7.50 4-pack $9.00 6-pack $11.50 12-pack $15.00 Note to CT residents: Please add shipping to your order before calculating sales tax. Shipping and handling is considered a taxable service under Connecticut State Law. Shipping Out of State: For correct shipping charges please call the winery during business hours at: (860) 868-7954 Phone Orders: Orders may be placed by calling the winery between 10:00 am and 5:00 pm daily at: (860) 868-7954 Gift Orders: Gift orders may be sent by filling out the ship to information with the shipping address of the person you want to receive the gift. There is a place to include a personalized gift card. Payment Information Mail this form with your payment to: Hopkins Vineyard 25 Hopkins Road New Preston, CT 06777 Payment Method Please check appropriate payment method ___ Check enclosed ___ Bill my credit card ___ Mastercard    ___ Visa   ___ AMEX Card# Expiration Date Signature Disclaimer All wines are sold in Connecticut and title passes to the buyer in Connecticut. We make no representation to the legal rights of anyone to ship wines into any state outside of Connecticut. The buyer is solely responsible for the shipment of wines. By placing an order, you authorize us to act on your behalf to engage a common carrier on your behalf to deliver your wine to you. Wines may be sold only to persons 21 years old. By placing an order, you represent to us that you are at least 21 years old. When your wine is delivered to you, you will be required to show identification proving that you are at least 21 years old. Signature