Order Form

Mixed Dozen Cases

Wine	Price Per Bottle	Quantity
Cabernet Sauvignon 2006	$18.00
Shiraz 2006	$18.00
Petit Rouge 2006	$15.00
Special Blend (Port)	$18.00
Sauvignon Blanc 2006	$16.50
Chardonnay 2007	$16.50
		$

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Standard Cases

Wine	Price Per Case	Quantity
Cabernet Sauvignon 2006	$216.00
Shiraz 2006	$216.00
Petit Rouge 2006	$180.00
Special Blend (Port)	$216.00
Sauvignon Blanc 2006	$198.00
Chardonnay 2007	$198.00
		$

Freight Charges per Case Delivered

Please Select Delivery - Metro Area or Country
Perth WA Bunbury to Augusta WA South West Western Australia Mid West Western Australia North West Western Australia Melbourne Victoria Country Sydney New South Wales Adelaide South Australia Country Brisbane Queensland Country ACT/Canberra Northern Territory/Darwin Tasmania

Cartons	First Case	Second Case +
Perth	$6.75	$6.75
Bunbury to Augusta WA	$6.75	$6.75
South West Western Australia	$6.75	$6.75
Mid West Western Australia	$7.75	$7.75
North West Western Australia	$10.75	$10.75
Melbourne	$15.55	$15.55
Victoria Country	$17.63	$17.63
Sydney	$15.55	$15.55
New South Wales Country	$17.63	$17.63
Adelaide	$16.83	$16.83
South Australian Country	$18.75	$18.75
Brisbane	$22.75	$22.75
Queensland Country	$29.95	$29.95
ACT/Canberra	$16.35	$16.35
Northern Territory/Darwin	$25.95	$25.95
Tasmania	$23.55	$23.55
		$

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Delivery Information

Surname :   First name :

Address :    Town/City :

State : WA SA VIC NSW QLD NT TAS ACT Other   Country :    Postcode :

Phone # :    Fax # :

E-Mail :

Special Delivery Instructions :




Payment Information

Card Holder's Name :

Card Number :

Expiry Date (mm/yy) :

Card Type : Cheque/Cash Bankcard VISA Mastercard AMEX


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