Print Wine Order Form - New Zealand

Please fill out the form, then print it and fax to (03) 445 0881. After each entry, press the TAB key or else use the cursor to go to the next entry area.

Personal Details

Name
Street (Delivery) Address

Town, District & Postal Code
Telephone
E-mail Address (required)

Free freight for orders of at least 12 bottles (mixed allowed).
Prices are in $NZ incl. GST for shipment within NZ only.

Wine

Price per Bottle

No. of Bottles

$ Total

2006 Dry Riesling	$ 25.00
2006 Riesling	$ 25.00
2006 Vin Gris	$ 24.00
2006 Chardonnay Elms	$ 24.00
2005 Pinot Noir	Sorry Sold Out
Freight First case: South Island $6.00 North Island $10.00 Additional cases free
GRAND TOTAL $

Credit Card Details

Card Card Type	Visa Mastercard
Card Number
Name on Card
Expiry Date
SIGNATURE

Please print now and fax to (03) 445 0881.

FELTON ROAD WINES · Bannockburn, R.D., · Central Otago · New Zealand
Tel. +64 3 445 0885 · Fax +64 3 445 0881 · E-Mail: Wines@FeltonRoad.com