Wine Consultants - Boursot's Wine Collection 

SECURE ORDER FORM

Please fill in all details below. Required fields are marked *

This form does not debit your card but simply sends a secured e_mail to Boursot's Wine Collection using SSL encrypted technology.

This form does not debit your card but simply sends a secured e-mail to Boursot's Wine Collection using SSL encrypted technology.

Rather than you having to re-type descriptions, you can simply copy & paste the wine's title from the price list into the Name of Wine field. (To do this, highlight the relevant text by pressing Ctrl & cap shift simultaneously, then Ctrl C to copy and Ctrl V to paste into the field below).

Name of Wine:No. of Bottles:Euro price
per bottle:
Euro
total
price:
SUB TOTAL €
less 10% €
TOTAL €



 


Collection Date:

Click on calendar icon
to select date
Approximate time required.
I wish to collect from:
ArdresMarquise
Name: **
Address Line 1 **
Address Line 2
Town: **
County:
Postcode: **
Country:
Email: **
Contact mobile number: **


Please complete the credit card details below.
We accept Visa & Mastercard debit + credit cards. Please use the tab button between fields, NOT the enter button!

Please note: our bank can only accept card numbers beginning with a 4 or a 5

Please enter details exactly as they appear on your credit card statement, or tick here to use the above details


Title
Cardholder's Name: **
Address Line 1 **
Address Line 2
Town: **
County:
Postcode: **
Country:
Email: **
Contact Phone Number: **

 

Credit Card Details

Card Type: Card Number: **
Expires:MM /YYCV2 Number:
(last 3 digits on the reverse of credit/debit card)
** **
Any other information:





I confirm that I am over 18 years of age  



Please enter today's date: (dd/mm/yy) cannot be backdated

Pressing the Submit Order button below will not debit your card but will transmit your secured information to Boursot's Wine Collection. Receipt of your order will be acknowledged via e-mail.

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