Please print up this order form with your details entered
and send it with a cheque for the total price

Mr Mrs Miss/Ms
         
Surname   First name
Name and
address for delivery
Telephone   Fax
E-mail *      
Date      

Product name
Cardboard number
Total
Product name
Cardboard number
Total
Product name
Cardboard number
Total
Product name
Cardboard number
Total
Product name
Cardboard number
Total
Product name
Cardboard number
Total
Product name
Cardboard number
Total
Product name
Cardboard number
Total
Product name
Cardboard number
Total
Product name
Cardboard number
Total
 
Sub-total
Cool of delivery
Overall total

In accordance with the French Freedom of Information and Data Protection Act of 6 January 1978, you have the right to access and modify any personal data pertaining to you.

Only our company or association will receive the information you are sending.

Route Nationale 112 34110 MIREVAL
Tél.: +33 (0)4 67 78 01 80 - Fax : +33 (0)4 67 78 11 71
cave.rabelais@wanadoo.fr
Enjoy your alcohol - Know your own limits and drink safely.