John and Pete's
Preliminary Order Form

Name:__________________________________________________   [ ] Bill me

Address:________________________________________________   [ ] Check

City:___________________________________________________   [ ] Money Order

State:_________________________________   [ ] Credit Card  Type: Visa/MC/AMEX/DIS

Zip Code:_________________________            Card#:_____________________________________

Phone#:___________________________          Exp. Date:_______

Billing Address for Credit Card:________________________________________________________

Email:_____________________________          Name on Card:______________________


Quantity    Description                                    Price
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Total # Items                             Sub-Total $  _________

________                 (CA residents) tax 8.25%  _________

                                                      Shipping  _________

                                                        Total $  _________

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John and Pete's Fine Wines and Spirits
 Mail: 621 N. La Cienega Blvd.
      West Hollywood, CA 90069
Phone: 310.657.3080       
  Fax: 310.657.9101
Email: orders@johnandpetes.com