If you don't feel comfortable ordering online (really, it's very safe), then just print out this form and fax it to us at
847-982-WINE (9463). we will calculate your total and contact you to confirm the order.

SHIP TO

Name

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Address

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City, State  Zip

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[ ] Daytime phone [ ] Evening phone (you must include one)

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Check one: [ ] UPS ground [ ] UPS 2-day [ ] UPS next day [ ] Schaefer's truck (click here for info)

BILL TO (if different)

Name

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Address

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City, State  Zip

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Daytime phone

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PAYMENT METHOD

Check one:   [ ] Visa  [ ] MC  [ ] Amex  [ ] Discover  [ ] Schaefer's Card

Credit card number

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Expiration

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Name on card

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Signature

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MY ORDER (include item#, quantity, and name)

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GIFT CARD TO READ

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Appropriate taxes, shipping, and handling charges will be added to the total.

All items are subject to availability. Prices may change without notice.