Wine Order

How many types of wine in this order?
Wine #1
Item Number*
Description*
Price per Bottle*
Quantity*
Wine #2
Item Number*
Description*
Price per Bottle*
Quantity*
Wine #3
Item Number*
Description*
Price per Bottle*
Quantity*
Wine #4
Item Number*
Description*
Price per Bottle*
Quantity*
Wine #5
Item Number*
Description*
Price per Bottle*
Quantity*
Order Total
Cost
$0.00
Number of Bottles
Delivery Info
Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Special Instructions
Payment Info
Payment Method*
- Online (via Paypal)
- Check
- Chase Quickpay
Paypal deducts a small transaction fee from every donation so please consider paying via Chase QuickPay or by check.
Please mail or deliver your check to:
Congregation Ohav Sholom
270 West 84th Street New York, NY 10024
Please send the Chase QuickPay payment to office@osnyc.org and indicate what the donation is for.
Billing Address*
Same as Delivery Address

Street Address Address Line 2 City State ZIP Code
Phone
This field is for validation purposes and should be left unchanged.

Wine #1