Phone 707-431-9146 • Fax completed form to 707-431-9146
Mail to Mojon’s Bench, PO Box 1849, Healdsburg CA 95448
Scan your completed order form and email to stephen@mojonsbench.com
Phone 707-431-9146 • Fax completed form to 707-431-9146
Mail to Mojon’s Bench, PO Box 1849, Healdsburg CA 95448
Scan your completed order form and email to stephen@mojonsbench.com
Mojon’s Bench Wines - Order by phone, fax , mail or email.
Ship To:
Name _______________________________________
Address _____________________________________
City ________________________________________
State ________ Zip ___________________
Email ________________________________________
Bill To:
Name _______________________________________
Address _____________________________________
City ________________________________________
State ________ Zip ___________________
Daytime Phone ________________________________
(required for shipping)
Order Form Quantity Total
2004 Mojon’s Bench Estate Merlot ________ ___________
2006 Mojon’s Bench Estate Merlot ________ ___________
2007 Syncopation ________ ___________
10% Discount on orders of 12 bottles or more ___________
CA residents add 9% sales tax ___________
Shipping-see left ___________
Total ___________
Method of Payment
____ Visa ____ Mastercard ____ Check
Credit Card No. _______________________________________________ Exp. _____________
Signature __________________________________________________________________________
_______ I certify that I am at least 21 years old.
Shipping
Actual shipping costs will be charged, based on weight. We will confirm your total including shipping charges by email...or...you may call us at 707-431-9146. The signature of an adult at least
21 years old is required at delivery.
We ship to the following reciprocal states: CA, OR, CO, ID, MN, NM, WA, IA, IL, MO, WI, WV. For all other
states, please call.
Quantities and Prices Per Bottle
04 Mojon’s Bench Estate Merlot $ 30
06 Mojon’s Bench Estate Merlot $ 28
07 Syncopation $ 36