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Example Wine Order Form

This wine order form offers a 10% discount for cases and the option to join a wine club.

Visitors place their order quantities, choose the shipping state from the pulldown menu (this can be customized to only include the states you ship to), fill out the 'captcha' info (to help eliminate spammers) and click on the 'Go to step 2' button which takes them to where they fill out their billing and shipping information.

This form can also calculate shipping per item, per state.

Wine 1   2009 Chardonnay ($20 per bottle)   QTY: 
         
Wine 2   2007 Pinot Noir ($25 per bottle)   QTY: 
         
   

Wine Club

    
  Join Eccentric Club
Receive 3 bottles mixed vintage every quarter
  Join Reds Only Club
Receive a 3 bottle red shipment every quarter


Shipping State:

Input text from image bellow:  





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