Vadai Wine Club Form

       Name __________________________________________________________

            Name of Business _________________________________________________________________

                Telephone # _________________________________ Cell # _______________________________

       **Business Shipping Address __________________________________________

                ____________________________________________________________________________________________________

       Shipping Address ____________________________________________

             City_________________________________________   State _________   Zip Code_____________

                   Payment Information:

        Check # ________________             Bank   _______________________________________________   

        Charge my Visa # ___________________________________   Exp _____________________

                  Charge my Mastercard __________________________     Exp ____________________

                   Signature Required ___________________________________ Date _________________

                                    ** Shipping  to a business address is less expensive**

                                 Thank You for ordering Vadai Wines !

                               Sandor & Ruthy Vadai