ORDER FORM

To be printed out and returned with your cheque or postal order.
Can be sent by E-mail if paying by credit card.


No order is accepted without payment.
Possibility to mix bottles in boxes of 6 or 12.



 

Amount :

Bottle :

Price per bottle incl. tax:

Total :

Cuvée réservée des Tsars        

1996

1995

1994

1993

1992

1991

Cuvée réservée de l'aieul        

1996

1995

1994

1993

1992

TOTAL AMOUNT OF MY ORDER :


Address for bill to be sent to :

Delivery address :

Mr                      Mrs                   Ms
Name: 
First name:
Address :


Postcode :
Town :
Tél. :
Fax :
Mr             Mrs           Ms
Name: 
First name:
Address :


Postcode :
Town :
Tél. :
Fax :


Delivery details :

 

Preferred delivery date :

Please inform me of the delivery at the following telephone number :

Delivery conditions :


Method of payment :

 
By cheque made payable to Château Eugénie

By postal order
 
By credit card (with the sign CB)........ Card number : 
Expiry date :  


Available soon : safe payment by credit card,courtesy of the Banque Populaire du Quercy et de l'Agenais.



Any comments :

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