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Bottled by :
ORDER FORM
AZNG Centennial Celebration Commemorative Wine (Presented by the AZ Enlisted Association) Ordered by (Name): ___________________________________________________ Contact me at (Phone or email): __________________________________________ Request the following bottles of wine at the buy-now auction price of: RED _____ x $22.00 = _________ WHITE _____ x $18.00 = _________ TOTAL DUE = $ _______________ I have enclosed: CASH ____ CHECK PAYABLE TO EANGA _____ NOTE: Payment is due in full upon delivery or when picked up from our POC.
FOR EANGA USE ONLY Amount Received: $ _________ (attached) Date Received: _____________ Received by: _______________ (EANGA Rep/POC Name) Wine was delivered on (Date): __________________________