Please print and fax form to (02) 6373 1248
or simply fill out and click the "Submit" Button below.
ORDER FORM
Enter Quantity desired, then click on "Calculate Results"
DESCRIPTION
QTY
PRICE/ea.
SUBTOTAL
Dolce Vita 2007
$14
$
Sauvignon Blanc 2008
$17
$
Cabernet Sauvignon 2006
$15
$
Pinot Noir 2008
$17
$
Alfresco Red 2006
$14
$
Shiraz 2006
$17
$
Vintage Port
$18
$
Prices are per bottle, however minimum order of a dozen bottles applies. Mixed dozens are allowed. Include any special requirements in COMMENTS section.
Freight/doz - NSW
$10
$
Freight/doz - VIC/QLD
$14
$
Freight to all other areas
on request
Order Total:
$
Customer Information
Name:
Address:
Town/City:
State:
NSW
QLD
SA
VIC
WA
NT
TAS
ACT
Postcode:
Country:
Phone:
Email:
Method of payment:
Visa
Mastercard
Card No:
Exp:
01
02
03
04
05
06
07
08
09
10
11
12
08
09
10
11
12
13
14
15
Cardholder Name:
Signature:
To claim 5% discount, please enter Seniors Card number
:
Comments:
"Caring for your health....and the environment"
Copyright © 2002 Martins Hill Wines