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TYPE OF WINE: House wine add $6.00 California Merlot add $8.00 Non alcoholic wine add $7.00 We will be sending you a bottle   When sending a bottle of wine to us, make sure you select a wine that has no label on one side. We will not remove labels.

QUANTITY:  1 2 3 4 5 6 For case pricing please call

The bottle as shown, contains 3 colors. Please select the number of colors.

PRICE: $40.00 three color fill $36.00 two color fill $32.00 one color fill $28.00 no colors         BOTTLE DESIGN: VALENTINE

ENGRAVED MESSAGE: I LOVE YOU HAPPY VALENTINE

NEXT  THREE  BOXES PERSONALIZE YOUR WINE BOTTLE

TOP NAME : 

BOTTOM  NAME :

YEAR TO BE INCLUDED ON BOTTLE: 2001 2002 2003 2004 2005 2006

BILL TO AND SHIPPING ADDRESS

FIRST NAME:     LAST NAME:

SHIPPING ADDRESS:

CITY:       STATE:    ZIP:

COUNTRY:

Include area code and country code

DAYTIME PHONE :        

HOME PHONE:

FAX:

If you are part of a fund raising effort with prior approval from Memories on a Bottle please list your organization below to assure the 10% donation. If you are not and would like to be, please call (919) 266-0261 for approval

ORGANIZATION:

North Carolina residents are required to pay 6% sales tax. Since all orders are customized, we will call to verify an order. Price does not include shipping or handling. We accept and .

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