JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Order Form - 2021 Holiday Promotion
2021年 ワインご注文書
Sign in to Google
to save your progress.
Learn more
* Indicates required question
御名前 Name
*
Your answer
お届先ご住所 Delivery Address
*
Your answer
御電話番号 Telephone
*
Your answer
ご購入ご希望の銘柄にご希望本数をご記入ください。Please indicate the number of desired bottles in the space provided below. (16 items total)
ご注文後メールにて確定させていただきます。All orders to be confirmed by email.
◆ Real Companhia Velha (Portugal / Douro) #1〜#4
1. Real Companhia Velha Espumante Bruto 2013 ¥3,800+Tax (sparkling)
Your answer
2. Quinta das Carvalhas Touriga Nacional 2014 ¥2,600+Tax (red)
Your answer
3. Quinta das Carvalhas Reserva Tinto 2014 ¥3,400+Tax (red)
Your answer
4. Quinta das Carvalhas Vinhas Velhas Tinto 2014 ¥9,200+Tax (red)
Your answer
◆ Quinta do Pôpa (Portugal / Douro) #4〜#9
5. Pôpa DOC Douro Tinto 2014 ¥2,400 (red)
Your answer
6. Pôpa DOC Douro Branco 2016 ¥2,400+Tax (white)
Your answer
7. Pôpa Black Edition Tinto 2014 ¥3,000+Tax (red)
Your answer
8. Pôpa Black Edition Branco 2015 ¥3,000+Tax (white)
Your answer
9. Pôpa VV (Vinhas Velhas) Tinto 2013 ¥5,200+Tax (red)
Your answer
◆ Bodegas y Viñedos Alto Sotillo (Spain / Ribera del Duero)#10〜#13
10. Rubiejo Rosado 2017 ¥2,400+Tax (rosé)
Your answer
11. Rubiejo Barrica 2015 ¥2,800 (red)
Your answer
12. Rubiejo Crianza 2015 ¥3,800 (red)
Your answer
13. Rubiejo Evolucion 2015 ¥7,800 (red)
Your answer
◆ Olive oil from the ancestral groves at Quevedo Port Wines #14
14. Azeite Virgem Extra (biologico) ¥2,400 (500 ml)
Your answer
◆ Port and Champagne Mini-Sale! P1〜P3
P1. Quevedo Reserve Ruby Port NV ¥2,400+Tax
Your answer
P2. Quevedo Special Reserve Tawny Port NV ¥2,700+Tax
Your answer
P3. Quevedo 10 Year Tawny Port NV ¥2,900+Tax
Your answer
◆ Champagne selections from Champagne Comtes de Dampierre
C1. Comtes de Dampierre Grande Cuvée Brut NV ¥5,300 （定価¥6,200)
Your answer
C2. Comtes de Dampierre Cuvée des Ambassadeurs 1er Cru NV ¥6,500 （定価¥7,600）
Your answer
C3. Comtes de Dampierre Blanc de Blancs Grand Cru NV ¥7,300 （定価¥8,600）
Your answer
ご意見・ご要望 Questions/Comments
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
Forms
This content is neither created nor endorsed by Google.
Report Abuse
Terms of Service
Privacy Policy
Help and feedback
Contact form owner
Help Forms improve
Report