Glenmore Wines Order Form

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Order Form

Please complete the order form below.

Minimum order six (6) bottles. Orders may be mixed.

Buy Wines by the bottle - minimum of 6 bottles - mixed wines allowed

SELECTION 1

Wine:

Type: Bottle Case

Number required:

Total $ amount:

SELECTION 2

Wine:

Type: Bottle Case

Number required:

Total $ amount:

SELECTION 3

Wine:

Type: Bottle Case

Number required:

Total $ amount:

SELECTION 4

Wine:

Type: Bottle Case

Number required:

Total $ amount:

SELECTION 5

Wine:

Type: Bottle Case

Number required:

Total $ amount:

SELECTION 6

Wine:

Type: Bottle Case

Number required:

Total $ amount:

FREIGHT COSTS

Minimum order six (6) bottles. Orders may be mixed.

Freight (6 bottles)	Freight (12 bottles)
WA, SA - $10 NSW, VIC, ACT - $10 QLD - $11 TAS, NT - $12	WA Free delivery NSW, VIC, ACT, SA - $12 QLD - $15 TAS, NT - $16

International Freight – price on enquiry

TOTAL ORDER

Sub Total for all wine selections:

Freight Total:

TOTAL:

DELIVERY INFORMATION

PLEASE NOTE: Australia Post will return wine to the nearest Post Office for collection if no one is home OR instructions to leave wine in a secure location are not indicated.

Delivery Address - number & street

City/Suburb:

Postcode:

State: WA SA NSW VIC ACT QLD TAS NT

Delivery Instructions:

CUSTOMER DETAILS

Name:

Email:

Daytime Telephone Number:

How did you hear about us? Google Friend Other

If 'Other' please state

Wine Preference? Red White

Age group? 20-30 30-40 40-50 Over 50

I would like to subscribe to your newsletter Yes No

PAYMENT - CREDIT CARD

Credit Card Type: Visa Mastercard

Card Number:

Expiry Date:

CVS:

Name on card:

Date:

OTHER PAYMENT OPTIONS

Pay by EFT/Direct Debit

NAB
BSB: 086 565
Acc: 578284943
Account Name: Glenmore Wine

Please use your surname as the reference.

Post

Click here to download the form (57KB)

Post, email or fax this form back to:

Glenmore Wines
PO Box 201
Yallingup WA 6282

Cheque enclosed. Please make cheques payable to Glenmore Wines

(F) 08 9755 2331 (E) ian@glenmorewine.com.au

Phone

Call Ian on 08 9755 2330

ABN: 40 763 258 587

SECURITY CODE

Please complete the Security Code below and then submit your order.

If you are unable to read the code please refresh it.

Thank you for your order, a copy has been sent to your email address.

We will be in touch soon.

Kind regards

Ian - Glenmore Wines

Sitemap

+61 8 9755 2330

Order Form

Freight (6 bottles)

Freight (12 bottles)

Pay by EFT/Direct Debit

Post

Phone