| 1. SELECT YOUR WINES: |
No.Bottles
required |
$Bottle |
$Carton |
$Line cost |
| Governor Robe Selection Chardonnay 2009 |
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| Governor Robe Selection Rosé 2010 |
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| Governor Robe Selection Cabernet Sauvignon 2005 |
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| Governor Robe Selection Merlot 2006 |
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| Governor Robe Selection Pinot Noir 2010 |
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| Governor Robe Selection Shiraz 2005 |
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| Total wine ordered: |
Number of bottles: |
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_________ |
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Normal wine price: |
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On-line order discount |
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On-line order wine price: |
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| Delivery within Australia to all capital cities |
No Pkgs |
$Package |
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| First carton/package (upto 12 bottles) |
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| Additional cartons/packages |
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| Total Delivery |
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| Total Shopping Cart amount >>>>>>>>>>>>>
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| 2. PAYMENT DETAILS: |
We accept the following credit cards  |
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| Credit card type: |
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| Credit card number: |
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| Valid until (mm/yy): |
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| Name on card: |
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| Note: order will not be delivered until payment is confirmed |
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| 3. CONTACT & DELIVERY DETAILS: |
| Your name: |
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| Your position: |
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| Organisation: |
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| Organisation Phone: |
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| Home Phone: |
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| Mobile Phone: |
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| Fax: |
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| Email: |
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| Street/Postal Address: |
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| Suburb/City: |
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| State/Territory: |
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| Post code: |
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| Delivery address if different to the above address |
| Street address: |
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| Suburb/City: |
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| State/Territory: |
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| Post code: |
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Other information:
Press [Enter] at the end of each line |
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| 4. PLEASE HELP US WITH OUR MARKET RESEARCH: |
| How you found us: |
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