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 2008
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

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

Olive Oil 2013
12x250ml at $120.00 per case

 

TOTAL

PAYMENT

 

Cheque

 

 

CREDIT CARD DETAILS

Credit Card

Name on Card:

Card Number:

Expiry Date:

 

 

Signature: ________________________