| GROUPE SOLEIL WINE ONLINE Order Form |
| E-mail to sales@groupesoleil.com or fax to 1-416-484-0830 |
| Company |
Licensee # |
| Name |
Phone # |
| Address |
Mobile Phone # |
| City |
Fax # |
| Province |
Postal Code |
| Email |
| |
| Payment |
VISA # |
| Name on Credit Card |
| Credit Card # |
Expiry Date |
| Signature (for faxed orders only) |
| |
| # Cases |
Product Name |
Price per case |
Amount |
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| SUB-TOTAL |
$ |
| GST |
$ |
| TOTAL |
$ |
| |
| Groupe Soleil Fine
Wines Private Consignment List |
| Stephen Cohen Tel
(416) 824-5004 Fax (416) 484-0830 Email gsoleil@rogers.com |
| Steven Baker Tel
(613) 862-1838 Fax (613) 726-9907 Email baker.steve@rogers.com |
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