ORDER FORM
Printable Order Form

To order, complete the form by filling in all your shipping information and entering quantities below.  Please then calculate the appropriate costs.  When form is completed, print this section or the entire page, enclose a Check or Money Order made payable to "The Bacchus Rack" and mail it to:

    The Bacchus Rack
    833 Siskiyou St.
    Ashland, OR 95720

If you would prefer ordering by phone, please call toll free 800-482-1776 and we will be happy to take your order over the phone. If so, we apologize for the inconvenience.
Your Name:*
Address Line 1:*
Address Line 2:
City:*
State:* (enter two-letter abbreviation) Zip:*
Daytime Phone:() * 
Email Address:*
Shipping Information   Shipping is per item.  Please
email if you have further shipping questions.

Item

 Qty Total Price Each  
#1 $
#2 $
#3 $
#4 $
#5 $
Sub-Total 
Shipping
TOTAL
Payment Information
I will be paying by:
Check made payable to The Bacchus Rack
Money Order made payable to The Bacchus Rack

If having a problem with any part of this order form please call toll free 800-482-1776
and we will be happy to take your order over the phone. If so, we apologize for the inconvenience.

Please call anytime and we'll be happy to answer any question you might have.

The Bacchus Rack · Ashland, Oregon · 800-482-1776 · info@thebacchusrack.com

Printable Order Form

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