First Name

Last Name

Email*

Phone

Address 1

Address 2

City

State

ZIP

What Type of Business Are You? (check all that apply)*

Restaurant

Retail

Gifts

Wine Club

Catering/Banquet

Distribution/Wholesaler/Importer

Not a Business

How Many Cases (12x750ml)* (select one)

<112

112

113-224

225-448

449-1029

FTL/FCL

Do You have Label Art Completed? Y/N

Yes

No

When would you like your wine order delivered?

ASAP

Within 2 Weeks

Within 1 Month

Whenever it coincides with a similar production run

Type of Wines (check all that apply)

White

Red

Sparkling

Sweet

List specific varietals:

Cost basis per BOTTLE:

<$8

$9-$12

$13-24

>$25

Do you prefer an appellation specific wine? Check all that apply

California

California Appellation

Santa Barbara County

Santa Ynez

Sta. Rita Hills

Santa Maria Valley

Paso Robles

North Coast

Mendocino

Napa Valley

Sonoma Valley

Russian River

Alexander Valley

Sonoma Coast

Oregon

Rogue Valley

Umpqua Valley

Willamette Valley

Washington

Columbia Valley

Walla Walla Valley

Other

Following submission of this form, we will contact you to discuss your specific needs. Based on a continued interest, we will ship samples for consideration.

Adults only (21+)

Private Label Wine Program Form