ZIMMERMANN WINE
order form
prices per bottle
Vintage
|
Price/bottle |
Quantity |
total |
|
Zimmermann shiraz 2005 |
$ 32.00 |
_______ |
$_____________ |
|
Zimmermann shiraz 2004 |
$ 38.00 |
_______ |
$_____________ |
Magnum / 1.5 LT
Zimmermann shiraz 2005 |
$ 128.00 |
_______ |
$_____________ |
|
Total Amount : |
$_____________ |
prices per dozen
Vintage
|
Price/bottle |
Quantity |
total |
|
Zimmermann shiraz 2005 |
$ 368.00 |
_______ |
$_____________ |
|
Zimmermann shiraz 2004 |
$ 437.00 |
_______ |
$_____________ |
|
Total Amount : |
$_____________ |
delivery
details
|
Your
Name : |
_________________________________________________ |
|
Address : |
_________________________________________________ |
| |
_________________________________________________ |
|
State / Postcode : |
_________________________________________________ |
|
Phone No.: |
_________________________________________________ |
payment
details
|
Cheque ___ / Money order ___ / Master Card
___ / Visa Card ___ |
|
Card
No: |
_ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ |
|
Expiry Date : |
__
__ / __ __ |
|
Name
on Card : |
_________________________________________________ |
Signature : |
_________________________________________________ |
Freight free delivery within Australia for a dozen only
Please print
and fill out the wine order form
Fax this
form to : +61 (0)8 8556 4078
Click here to open
printer friendly page
|
