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Wine Barrel Plus makes no representation or legal claim concerning the rights of any
person to ship or import alcoholic beverages into any state and/or country. All items
purchased from Wine Barrel Plus are considered sold in Michigan.

Because these orders originate from Wine Barrel Plus, all orders are charged the local
sales tax of (6.0%) levied by the state of Michigan.

1% of the total purchase price will automatically be added to your order to cover any
breakage or loss that may occur. If you would like to decline this coverage please check
the acceptance line on this shipping form. By waiving the guarantee you release Wine
Barrel Plus of any and all responsibility of breakage or loss that may occur to your order.

____ I Do Not Accept the 1% charge for breakage or loss

Legal Age

You must be at least 21 years of age to purchase wine. By placing your order you have
represented to Wine Barrel Plus that you are at least 21. All wines delivered must be
received by an adult of legal drinking age showing proper I.D.; this also includes items
shipped out of the United States.

***All first time orders will be required to submit proof of age via fax legible copy
of drivers license with date of birth circled. Please also mail this form and a legible
copy of your license to with date of birth circled***

30303 Plymouth rd
Livonia MI 48150
Fax 734-522-3764

Print Your Name in full including middle initial.

_________________________________

I agree to the above.

Signature_________________________________


Date____________________________________


Date of Birth_______________________________

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