Hackersley Order Form

ORDER FORM

To order please fill out your details and submit your completed order online.

Please print out, sign and fax your order to Hackersley Wines on: (08) 9383 3364

Delivery costs are included for customers in the Perth Metro area.
Customers outside of this area will not be charged until contacted
and delivery details confirmed.

Name:
Address:
Post Code:
Telephone:
Email:

VARIETY

CASES

COST

Shiraz 2007
at $300.00 per case

Cabernet Merlot 2007
at $300.00 per case

Merlot 2007
at $300.00 per case

Shiraz Cabernet Merlot 2006
at $300.00 per case

Cabernet 2008
at $300.00 per case

Merlot 2003
at $300.00 per case

Merlot 2004
at $480.00 per case

Sauvignon Blanc 2006
at $216.00 per case

Semillon 2006
at $216.00 per case

Sauvignon Blanc Semillon 2008
at $216.00 per case

Verdelho 2011
at $216.00 per case

TOTAL

PAYMENT
				Cheque
CREDIT CARD DETAILS				Credit Card

Name on Card:
Card Number:
Expiry Date:
Signature: ________________________