DELIVERY ADDRESS: 

SURNAME:

GIVEN NAME:

STREET NUMBER:

STREET:

TOWN:

POSTCODE:

PHONE NUMBER:

FAX NUMBER:

EMAIL:

POSTAL ADDRESS:  If same as delivery address leave blank

SURNAME:

GIVEN NAME:

STREET NUMBER:

STREET:

TOWN:

POSTCODE:

PAYMENT METHOD:

Cheque: Make payable to Craig Benjamin

Card: Circle the type of card:

   Mastercard  /  Visa  /  Bankcard

Expiry Date:

Card Number:

Signature:

WINE

PRICE EACH

QUANTITY

TOTAL

Chocolate Hills 2005 Choc Cabernet Swirl

$12.00

Chocolate Hills 2004 Shiraz

$12.00

Chocolate Hills 2006 Chard/Verdelho

$12.00

Chocolate Hills 2006 Riesling

$12.00

Chocolate Hills 2005 Verdelho

$12.00

Chocolate Hills Brut/Cuvee

$12.00

Chocolate Hills Tawny Port (1 Litre)

$12.00

FREIGHT

Phone for Freight Charges

TOTAL

POSTAGE:  Free postage to Newcastle and Sydney areas. Other areas will be charged postage according to weight.  Please contact us if you would like to know postage prior to placing an order.