STAGECOACH EXPRESS & CO.
3379 SOLANO AVE., NAPA, CA.94558 (707)257-1888 FAX-(707)257-1891 TOLL FREE-(877)232-5054
WWW.STAGECOACHEXPRESS.COM
COMMERCIAL/BUSINESS ADDRESS IS ALWAYS RECOMMENDED
SENDER: DATE:______SHIP TO: BUSINESS RESIDENCE
BILLING INFORMATION (+$8/PKG)
REQUIRED FOR CREDIT CARD PLEASE WRITE CLEARLY WE WILL NOT INSURE WINES TO: AL,AR,KS,MO,MS,PA,NJ,NY,VA ______
First name last name First name last
______
Company name Company name
______
Address Address (No PO BOX #’S) STE/FL #
______
City State zip City State zip ______
Phone: Phone:
______
Email: Required for Tracking TRACKING SENT TO EMAIL BY UPS QUANTUM VIEW-CHECK SPAM/JUNK FOLDER
PRINT CLEARLY______
NO SHIPMENTS INTO MA,ND,NH,WV— UT COMMERCIAL ONLY
ADULT(21+ YRS.)SIGNATURE REQUIRED FOR DELIVERY
LIST BOTTLE COUNT: ______LIST WINERY/VINTAGE/VARIETAL:
______
______
PLEASE DECLARE VALUE OF WINE/CASE: $$______
INSURANCE RATE:$3/per $100 of value/,EXAMPLE INSURE FOR $600/CS =$15/BOX-CS.
INSURANCE IS FOR LOSS/BREAKAGE ONLY; NO HOT/COLD COVERAGE. INCLUDES: PUSHED CORKS, COOKED WINES, SEEPAGE, RUINED LABELS/FOILS,LATE DELIVERIES.
STANDARD INS. $100/BX ______(Initials)
My initial above WAIVES ADDITIONAL INSURANCE. MY SHIPMENT WILL HAVE $100/INS. PER BOX.
CLAIMS MUST BE MADE WITHIN 3O DAYS FROM SHIP DATE
PLEASE CIRCLE ONE:
SERVICE: GROUND/5-7WK.DAYS 3DAY 2DAY NEXT DAY
SHIP: ANYDAY ANYDAY MON-WED MON-THURS
Est. COSTS PER CASE: $55-$70 $100-$112 $110-$122 $150-$165
EST. IS DETERMINED BY STATE-CALL TO INQUIRE
Cs +42lbs will be charged surcharge—6pks +22lbs charged surcharge of $3/lb.
TERMS/CONDITIONS: SENDER AUTHORIZES STAGECOACH EXPRESS & CO TO CHARGE CARD & SHIP THIS PARCEL WITH ABOVE TERMS.SENDER AGREES TO PROVIDE CURRENT INFORMATION ON SHIP TO: IF ADDITIONAL CHARGES OCCUR, SENDER AGREES TO PAY ALL CHARGES. RETURNS/ADDRESS CORRECTIONS WILL BE CHARGED TO SENDER IF FAULT OF SENDER/RECEIVER
SIGNATURE OF SENDER/CREDIT CARD HOLDER: I DECLARE I AM 21+YRS.
****
CREDIT CARD #:______
Ex. Date: ______3 DIGIT SEC. CODE FOR CC BILLING: ____
NEED WINE BY SPECIFIC DATE? PLEASE SPECIFY: ______WE WILL DO ALL THAT WE CAN TO ACCOMMODATE YOUR NEEDS. WANT YOUR WOOD BOX? Y N COSTS TBD AT SHIPPING.
IF FORM IS NOT COMPLETE, YOUR WINE WILL NOT SHIP!!!!!!!