551 KERERU ROAD, RD1 HASTINGS, NEW ZEALAND
PH (06) 874 9668 FAX 06 874 9670 EMAIL US

WINE ORDER FORM | Only NZ customers may use this form to purchase wines.

Please fill in ALL fields before clicking the “Submit” button. You may also print out the form and fax it to (06) 874 9670. MINIMUM ORDER OF 6 BOTTLES.

You will receive a confirmation that your order has been receieved with details of the bank account to direct credit or deposit the total amount to.

Address Input

First Name:	*
Last Name:	*
Street:	*
City:	*
Region:	*
Postcode:	*
Phone:	*
Email:	*

Special discount of 10% included on case prices!	Bottle Price	Case Price	Total
2009 HRWE Tempranillo	$29.00	$313.20	$
2009 HRWE Pinot Noir	$24.95	$269.46	$
2010 HRWE Viognier	$24.95	$269.46	$
2009 HRWE Pinot Gris	$22.95	$247.86	$
2010 HRWE Rose	$18.95	$204.66	$
2009 HRWE Semillon	$19.95	$215.46	$

			$
Delivery (per dozen or less) $8.00 North Island - $8.00 South Island -			$
Grand Total (all prices are GST inclusive)			$

Delivery Information (if different from above)

Name:		Phone:
Address
I accept that I have read the terms & conditions
I am over the age of 18 years

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