The security of your information is of utmost importance. This is why we make use of the most secure technology available for every transaction.

To learn more about this technology please click below to read our privacy statement.

Fax/Mail Order Form

Please use the following form for FAX and Mail orders only. To use our SECURE online form, click here. Simply print the form, indicate your selection and fax or Mail to:

JungWines
400 Manor Rd
Delmont,PA
USA 15626

FAX # 1-724-468-4559

Premium Wines	Quantity
Red		x 6.49
White		x 6.49
Rosé		x 6.49
Varietal Wines	Quantity
Riesling		x 7.24
Merlot		x 7.24
Sparkling Wines	Quantity
White		x 7.99
Peach		x 7.99
Trial Pack	Quantity
Shipping Rates:                           First bottle - $7.50                            next 11 bottles - $1.50/bottle Each additional partial case (< 12 bottles)                          charged as above Additional full cases(12 /case) - $20.00/case                           Continental USA only                           - other customers inquire here.
Product Total: _____________________US$
Shipping Total: _____________________US$
Order Total: _____________________US$
Name : __________________________________ Address : __________________________________ City : __________________________________ State : _____________________ Zip Code : __________________________________ Email Address: for shipping __________________________________ Telephone: __________________________________ Payment Method:  Visa Mastercard   Discover    American Express Card Number : __________________________________ Expiry Date : ______________________ Name on Card: __________________________________ CVV # Last 3 digits on back of card ______________________ Shipping address if different from above Name : __________________________________ Address : __________________________________ City : __________________________________ State : _____________________ Zip Code : __________________________________ Telephone: _____________________