_printable-order-form

Please fill in the form; print out two copies -one is for your record- send the other to the address at the bottom of the page.

<Place your cursor in the box and you can fill in the form using your keyboard - then simply print it.>
_Happy-Painting

VISA

MasterCard

Check

Money Order

(EX: 0000-0000-0000-0000)

(EX:MM/YY)
ccv

NEW! We need the 3 digit CCV Number:                

All Orders are Payable in US Funds Only. There is a $30.00 fee on all checks returned for insufficient
funds. To calculate shipping costs for your order, please click on the "Shipping Info" link above.
Prices subject to change without notice. We reserve the right to refuse service to anyone.
*Please send remittance or correspondence to:
Between the Vines, Inc, P.O. Box 278, Myrtle Creek, OR 97457