Magnedibles® - New Account Order Form

Returning Customers
If your company has already placed an order with us in the past, please login to your Customer Area. Can't find your customer login info? Let us know and we'll re-send you your password.

New Customers
All items we manufacture are CUSTOM-MADE to look just like your product. If you're a new customer looking to place an order with us, please complete the form below and we'll e-mail you a login info to your dedicated Customer Area where you will be able see your pricing, confirm and track the progress of your new order, and later, re-order previously delivered items.

Billing Info	(select and type over)
Company Name Billing Address City, State, Zip Phone and Fax

Shipping Info	(same as billing)
Company Name Shipping Address City, State, Zip Phone and Fax (Tip: Copy and Paste from "Billing Info" field if the same.)

Buyer's Full Name:	Name of authorized buyer
Title:
E-mail:
Phone:	( ) (ext.)
Fax:	( )
Does your company issue Purchase Orders?
Comments/Requests:

If you're ready to proceed with a new order, complete the information below, or simply scroll down and hit the "Submit Info" button.

Note: Change the quantities of any item below as needed. An account with be created and a final invoice with the adjusted quantities, items and pricing will be e-mailed to you.

Your P.O. # (if any)
Brand	Varietal	Vintage	Bottle Style	Quantity

Magnedibles, Inc. • PO Box 151516 • San Rafael, CA 94915 • USA
(877) 777-8209 (Intl.) (415) 279-2911 - Fax (415) 634-3198