Online
Order Form
INSTRUCTIONS:
Fill in all details and then click the SUBMIT
BUTTON at the very bottom of this form
HERMITAGE
PREMIUM WINES PTY. LTD.
ABN: 66 093 788 428 ACN 093 788 428
Direct
Sales Licence Number: 51400198
If you wish
to purchase a mixed dozen or are ordering from overseas please ring
0438 837 834 / (+61)438 837 834
OR
email John 
direct.
OR print
THIS
FORM (click to download) and Fax/Post
it to us - (needs Acrobat
Reader click to download) |
| Description |
Price |
Quantity
(in whole dozens) |
Total |
NV Reserve Sparkling
Riesling Blend (SA) |
$
|
|
|
| 2008 "Blakiston"
Sauvignon Blanc (Adelaide Hills) |
$
|
|
|
| 2009 "Blakiston"
Sauvignon Blanc (Adelaide Hills) |
$
|
|
|
| 2008 "Blakiston"
Chardonnay (Eden Valley) |
$
|
|
|
| 2006
Colombard Blend (Adelaide Plains) |
$
|
|
|
| 2004 Sparkling
Merlot (Adelaide Hills) |
$
|
|
|
| 2004 Reserve Pinot
Noir (Adelaide Hills) |
$
|
|
|
| 2004 Reserve Merlot
(Adelaide Hills) |
$
|
|
|
2009
Sparkling Riesling Traminer(Adelaide Hills) |
$
|
|
|
2009
Tilbrook Chardonnay(Adelaide Hills) |
$
|
|
|
| 2008 Reserve Shiraz
(Eden Valley) This Month's Special |
$
|
|
|
| |
Total Dozens
|
|
|
| |
| |
|
| |
Delivery |
|
| |
|
| |
| |
GST included |
|
Personal
and Delivery Details
(Please
Note: Delivery can only be made to a person 18 or older)
Required fields
are marked with a *
|
Name |
* |
|
| Address
Details: |
No and Street |
* |
|
Suburb |
* |
|
State |
* |
|
Post
Code |
* |
|
Phone
Number/s (including area code) |
|
|
Email
(to send confirmation of order) |
* |
|
| Payment
Method and Details |
| I
will send via a cheque/Money Order
OR Direct Deposit
Account Name: Hermitage premium Wines
BSB: 065-149
Account Number: 10190569
|
|
(Please click if paying via cheque/order/direct deposit)
* OR
|
| I
will be using the following Credit Card |
|
(Please click if
supplying card details) |
| Card
Number |
|
|
| Expiry
Date |
|
|
CCV (Security code on back of card - last 3 digits) |
|
|
Name
on Card |
|
|
Card
Type |
|
|
| I
certify that I am 18 or more years of age |
* |
Please
tick.
(It
is an offence to misrepresent your age) |
| Comments |
|
|
|
I
understand that my order will be filled when the cheque/order/card
has been processed.
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
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