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