ORDER
FORM/TAX
INVOICE
GST
86-230-526
Date:
(just print out this form and fill it in)
| Wine |
Quantity | Price |
Total |
|
| Denton
Pinot
Noir
2003 |
SOLD OUT | bottles | $24.50 |
|
| Denton Folly 1999 |
SOLD
OUT
|
bottles | $28.00 |
|
| Denton Folly 2000 |
SOLD
OUT
|
bottles | $28.50 | |
| Grand
Total
(inc
GST) |
| Your
Name: |
Telephone
number:
|
| Delivery
address: |
Special
Instructions: |
| Mastercard /
Visa / |
e-mail: |
| Number: |
I am over 18, |
| Expiry Date: |
Signature: |