Your Name:           
Email Address:       
Address:                
Phone Number:      
Special Delivery Instructions:

2004/2005 Petit Verdot  @ $15.00 per Bottle : Quantity
2007 Chardonna y          @ $15.00 per Bottle:  Quantity
2004/2005 Shiraz           @ $15.00 per Bottle : Quantity 
2005 Cab Sav                @ $15.00 per Bottle : Quantity
Total Wine Purchase $

Postage will be added at the following rates:
Adelaide                        $8.00     per mixed dozen
SA Country                   $12.00    per mixed dozen
Other Aus Capitals        $16.00   per mixed dozen
Other Country Areas     $20.00 + per mixed dozen

Please nominate your Payment Method :
(Credit Card, Cheque, Money Order, Cash on Delivery, Direct Bank Credit, Collection)
When you submit we will receive your order.
We will then contact you to arrange payment and delivery.
Customers must be over 18 and orders will not be delivered to unattended premises
License Number 50804187.
All prices include GST