Name *

First Name

Last Name

Shipping Address *

Please enter an address to receive your wine shipment. Someone 21+ years of age must be able to sign for package at time of delivery. Signature is required.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Please enter your contact number for any shipping delivery arrangements and/or questions.

(###)

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Age Declaration *

I understand that I must be 21 years of age or older to purchase and ship wine. I declare that I am of legal drinking age:

Yes

No

Birthdate of Purchaser *

MM

DD

YYYY

WINE OPTION CHOICE(S) *

Option One

Option Two

Option Three

Option Four

DISCLAIMER *

Wine purchase shall be made and sent directly with/from selected Winery. Italy Unfiltered is acting solely as sales mediato. Italy Unfiltered is not a winery or wine distributor.

Yes, I understand and agree