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Uncorked Wine Order Form - 3/7/2024

Uncorked Wine Order Form - 3/7/2024
Full Name*
First Name Last Name
E-mail*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*

Area Code Phone Number
Total * Add 5% for CC or Paypal

$
Delivery within DFW

$40
Total

$0.00

Payment*

Credit Card Paypal Zelle (no 5% fee)

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