|
Dionysus
Winery Order
Form |
|
TAX
INVOICE ABN: 36 583 780 692
Please complete
all details, print this page from your browser and sign it.
For cheque orders, send to 1 Patemans Lane, Murrumbateman, NSW, 2582.
For credit card orders, send to the above address OR fax to (02) 6227 0209.
Name
Postal
address details:
Address
Suburb/City
State Postcode
Contact
telephone number or email address
Delivery
address details (if different from above):
Address
Suburb/City
State Postcode
Payment
options:
Cheque
enclosed Credit card
(details below)
Credit
card details:
Type of
card: Bankcard
Mastercard
Visa
Credit
card number Expiry
date
Name on
Card Signature
______________________
|
Wine |
Price per bottle |
Number of bottles |
Value |
|
2011
Riesling |
$20.00 |
|
$ |
|
2010
Sauvignon Blanc |
$19.00 |
|
$ |
|
2009
Chardonnay |
$20.00 |
|
$ |
|
2009
Pinot Noir |
$26.00 |
|
$ |
|
2008
Merlot |
$22.00 |
|
$ |
|
2009
Murrumbateman Shiraz |
$15.00 |
|
$ |
|
2009
Estate Shiraz |
$24.00 |
|
$ |
|
2008
Cabernet Sauvignon |
$22.00 |
|
$ |
|
Dozen discount (10%) |
$ |
||
|
Freight * |
$ |
||
|
TOTAL ORDER |
$ |
||
*
Delivery within the ACT is free, otherwise delivery charges (per dozen) apply
Delivery
$15