Hermitage Premium Wines - Club Application Form

Hermitage Premium Wines
Wine Club Application Form
INSTRUCTIONS: Fill in all details and then click the SUBMIT BUTTON at the bottom of this form

FREE Membership entitles you to:

	Notification of Special Offers Club Discounts on our wines View Club Pricelist Here
Full Name		*
Phone Contact/s

Email Address		*
I certify that I am 18 or more years of age		*	Please tick. (It is an offence to misrepresent your age)
Comments
Fields marked with a * are required

WARNING: Under the Liquor Control Reform Act 1998 it is an offence:
To supply alcohol to a person under the age of 18 years (Penalty $2,000).
For a person under the age of 18 years to purchase or receive liquor (Penalty $500).
Liquor will not be supplied to a person under the age of 18.
Orders will not be left unattended.
All orders must be signed for by a person over 18 years of age.
Direct Sales Licence Number: 51400198