Order Form Ficha de Compra La Bodequilla Constantino Garran,3 26300 NAJERA - La Rioja Tel: Int'l + 34 941 36 23 13 Fax: Int'l + 34 941 36 36 92

   Wine/Vino       Winery/Bodega       Qty/Cantidad      Price/Precio
   ---------       -------------       ------------      ------------

1. _____________   ______________      ____________      ____________

2. _____________   ______________      ____________      ____________

3. _____________   ______________      ____________      ____________

4. _____________   ______________      ____________      ____________

5. _____________   ______________      ____________      ____________

6. _____________   ______________      ____________      ____________

7. _____________   ______________      ____________      ____________

8. _____________   ______________      ____________      ____________

                                          Shipping/Envio ____________

                No Cases/Cajas _____            TOTAL    ____________


Name/Nombre       _________________________  E-mail     _____________

Address/Direccion _________________________  Telef/Fax  _____________

                  ________________________   VISA    ________________

                  _______________________   Expr/Caud  ______________


Signature/Firma  ________________________   Date/Fecha ______________

Note: Substitute sold-out labels for next available vintage: Yes/No
Nota: Sustituir añadas agotadas por la añada siguiente: Si/No

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