Charity Wine Auction Beverage Pour Confirmation

Please fill out the fields below for EACH wine/beer/spirit brand being poured. If you are featuring more than one brand, you will be required to fill out another form.

Company *

Agent Name *

Email *

Phone Number *

Winery * Winery Principle name, email photo, and biography for program (if applicable)

Download and Sign AHS Form Email Photo, Biography, Proof of Insurance and AHS Form

Did you email your photo, biography (if applicable), proof of insurance and signed AHS form to Samantha Nelmes? (If not, please click the button above to email your document(s)) Yes

Product 1 Name & Vintage * mandatory

Product 2 Name & Vintage * if applicable

CSPC 1 * mandatory

CSPC 2 * if applicable

Suggested Case Quantity 1 * mandatory

Suggested Case Quantity 2 * if applicable

Product 3 Name & Vintage * if applicable

Product 4 Name & Vintage * if applicable

CSPC 3 * if applicable

CSPC 4 * if applicable

Suggested Case Quantity 3 * if applicable

Suggested Case Quantity 4 * if applicable

Product 5 Name & Vintage * if applicable

Product 6 Name & Vintage * if applicable

CSPC 5 * if applicable

CSPC 6 * if applicable

Suggested Case Quantity 5 * if applicable

Suggested Case Quantity 6 * if applicable

Number of Staff * Names AND Proserve Numbers of Staff Members Pouring at Event * If you require more fields for products or have any additional questions, please contact Samantha Nelmes at samantha@willowpark.net