| Fax this form to: | 02 6230 2023 | or mail to: |
Brindabella Hills Winery
156 Woodgrove Close Via Hall, NSW 2618 AUSTRALIA |
| Name: | |
|---|---|
| Address: | |
| Phone: | |
| Delivery Instructions: | |
| Qty | Product ID | Description | Price | Doz Price | Total ($) |
|---|---|---|---|---|---|
| 01_2007SHRZ | 2007 Shiraz | $28.00 | $25.00 | ||
| 02_2008BRI | 2008 Brio | $20.00 | $18.00 | ||
| 03_2004R | 2009 Riesling | $25.00 | $22.50 | ||
| 04_2009AU | 2009 AUREUS Viognier/Chardonnay | $25.00 | $22.50 | ||
| 05_2007SauvB | 2009 Sauvignon Blanc | $18.00 | $16.50 | ||
| 06_2008ARG | 2008 Argenteus | $20.00 | $18.00 | ||
| 07_2006SSH | 2005 Sangiovese Shiraz | $18.00 | $16.50 | ||
| 08_2009PG | 2009 Pinot Gris | $20.00 | $18.00 | ||
| 09_2008WRo | 2008 Wild Rose | $18.00 | $16.50 | ||
| (Freight: $15/case within Australia) | Freight: | ||||
| Total: | |||||
| [ ] Please debit my credit card | [ ] I enclose a cheque for: $ |
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| Card Type: | [ ] Visa [ ] Mastercard [ ] Bankcard | |
| Name on card: | ||
| Card No.: | ||
| Expiry Date: | ||