To Order

DICKERSON VINEYARD LIMITED RESERVE ORDER FORM

Please mail payment to address below or charge by FAX to (650) 745-0681

Dickerson Vineyard Wine Sales

37 Seminary Cove Drive

Mill Valley, CA 94941

2002 NAPA VALLEY MERLOT ___ cases @$300.00 = $________
CA: Add $12.42 tax /cases + $25.00 shipping ___ cases @$337.42 = $________

2002 NAPA VALLEY ZINFANDEL ___ cases @$335.00 = $________
CA: Add $25.13 tax /cases + $25.00 shipping ___ cases @$385.13 = $________

2001 NAPA VALLEY RUBY CABERNET ___ cases @$200.00 = $________
CA: Add $11.25 tax /cases + $25.00 shipping ___ cases @$236.25 = $________

SHIPPING IS POSSIBLE TO RECIPROCAL STATES ONLY

TOTAL $ ______________

SHIPPING INSTRUCTION ( PLEASE PRINT )

Name: _______________________________________________________

Street: ________________________________________________________

City, Zip:___________________________

Phone _____________________________

Email address_______________________

Visa/Master Cd # ___________________________________Expiration:_ _ /_ _

Signature _________________________________________