|
WINE ORDER FORM
Title: Mr. / Mrs. / Ms. / Dr.
Name: _______________________________________________________________
Delivery Address: _______________________________________________________
City: __________________________________ State: _________ P.Code: ________
Telephone: _________________________ Facsimile: __________________________
email: _______________________________________________________________
Special delivery instructions: ______________________________________________
____________________________________________________________________
|
|
Cellar List
|
Price/Bottle
|
Price/Case (6)
|
Qty
|
Total Amount
|
|
Roxy’s Paddock Shiraz 2006
|
$28.00
|
$150.00
|
|
|
|
Lakeside Marsanne 2007
|
$22.00
|
$118.00
|
|
|
|
All prices include GST
|
|
Freight
|
|
|
|
Total (including Freight)
|
|
|
|
|
|
|
Â
Â
Â
Freight per case: Melbourne & Victoria: Free, Adelaide & Sydney $12, Brisbane $13,
North Queensland & Perth $15. Other destinations, contact us.
Payment:
* Cheque: Please make cheques payable to Armstead Estate and send with order form to:
Armstead Estate
366 Moorabbee Road
Knowsley Vic 3523
* EFT: Bank CBA, BSB 063 194, Account Number 1005 0267, Name Peter Armstead
(Please use last name as reference on deposit, fax order form to 03 5439 1363, wine will be shipped upon receipt of funds)
* Credit Card: Please select: __ Mastercard __ Visa
Card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp: __ __ / __ __
Name on card: ________________________________________________
Signature: ____________________________________________________
Please fax form back to 03 5439 1363 or mail to:
Armstead Estate
366 Moorabbee Road
Knowsley Vic 3523
|
