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					                                       COLLECTOR
                                                      WINES

                                                  ORDER FORM

               Vintage     Product                                  Cost/btl.*     Quantity            Total



                           Marked Tree Red Shiraz
               2008        (screwcap – dozens)                      $26.00




                           Reserve Shiraz
               2008        (screwcap – 6 packs)                     $46.00
                           Limit – one 6 pack per customer



                                                                     *GST Incl.
Please make mail orders in lots of 6 or 12.                                         Wine Value

Freight rates for wine deliveries
                                                                                         Freight
$8.00 per case in the ACT
$14.00 per case anywhere else in Australia.
Remember to include the freight charge in your order.
                                                                                         TOTAL

Your Details


Name:

Address

Tele phone:              ( h)                            (w)                              (m)

Email:
                         (tick) Please add me to the Collector Wines mailing list (Email only)

Delivery Details


Contact name:

Address
Delivery
Instructions:

Payment Details
Credit Card                     Visa               Mastercard            American Express
(tick):

Card No.:

Cardholder’s
Name (print):                                                                     Expiry Date
I certify that I am over 18 years of age:

Signature:                                                                                      DOB:

By cheque:               Cheques should be made payable to Collector Wines Pty Ltd. Goods will not be
                         dispatched until funds are cleared

                                                      Thank you.
                                             Collector Wines Pty Ltd
                                                   12 Bourke St.
                                               Collector NSW 2581
                                   Tel: +61 2 6116 8722 Fax: +61 2 6247 7682
                   ABN 43 126 378 658 Agent for the licensee of liquor licence number 24014015
                           collect@collectorwines.com.au www.collectorwines.com.au

				
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Description: COLLECTOR