1. Contact & Shipment Info  
 
First Name*
 
 
Last Name*
 
 
 
Phone*
 
 
 
 
Email*
 
 
 
 
Timeframe or Date of Shipment
 
 
 
 
Number of Bottles to Be Shipped
 
 
 
 
2. Pick-Up Address & Contact Information   
 
Name
 
 
 
 
Phone
 
 
 
 
Street Address
 
 
 
 
Address Line 2
 
 
 
 
City
 
 
 
State
 
 
Zip Code
 
 
 
 
Location Type
 
 
 
 
   
 
 
Loading Options
 
 
 
 
 
 
 
Will a full sized (53 Feet or larger) freight truck have access for pick-up?
 
 
 
 
 
 
 
3. Delivery Address & Contact Information  
 
Name
 
 
 
 
Phone
 
 
 
 
Street Address
 
 
 
 
Address Line 2
 
 
 
 
City
 
 
 
State
 
 
Zip Code
 
 
 
 
Location Type
 
 
 
 
 
 
 
Loading Options
 
 
 
 
 
 
 
Will a full sized (53 feet or larger) freight truck have access for pick-up?
 
 
 
 
   
4. Additional Information  
 
 
 
 
Will you need help packing the wine into boxes?
 
 
 
 
 
 
 
Is the wine currently on a pallet in a local warehouse or retail store?
 
 
 
 
 
 
 
Our estimate includes inside delivery, would you also be interested in unpacking services?
 
 
 
 
 
 
 
Shipment transit time takes 14-21 days; will you need temporary storage?
 
 
 
 
 
 
 
Do you need insurance coverage for the wines while in transit? Most homeowners policies do not cover wine during transport.
 
 
 
 
 
 
If you answered yes above, what is the value of your shipment?
 
 
 
 
 
 
 
Please indicate below if there are any additional instructions for your wine shipment.
 
 
 
 
How did you find Domaine Storage?