MEMORIES ON A BOTTLE

Wine bottle order form

For Wedding Bells

877-580-5984

You have your choice between alcoholic and non-alcoholic wine. Through Duplin wine, we will only ship alcoholic wine in the state of North Carolina. We will call you to verify an order and to receive payment

E-MAIL ADDRESS(required)

TYPE OF WINE: 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: For case pricing please call.

The bottle as shown, contains 2 colors. Please select the number of colors.

PRICE: BOTTLE DESIGN:

NEXT FOUR BOXES PERSONALIZE YOUR WINE BOTTLE

FIRST NAME 1:

FIRST NAME 2:

LAST NAME TO BE INCLUDED ON BOTTLE:

DATE TO BE INCLUDED ON BOTTLE:

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 .

Your comments or recommendations on images is greatly appreciated.

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