Dionysus Winery

Order Form

http://www.dionysus-winery.com.au/images/Logo3.jpg

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

2009 Riesling

$19.00

$

2009 Sauvignon Blanc

$19.00

$

2008 Chardonnay

$10.00

$

2008 Pinot Noir

$25.00

$

2008 Merlot

$22.00

$

2007 Cabernet Merlot

$22.00

$

2007 Shiraz

$30.00

$

2008 May Riesling (375mL bottle)

$20.00

$

Dozen discount (10%)

$

Freight *

$

TOTAL ORDER

$

* Delivery within the ACT is free, otherwise delivery charges (per dozen) apply

Delivery $15

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