Pemberley Farms

Order Wine

To order within Australia, fill out & print the form below and return via fax or post or post to:
Pemberley Farms, Box 107, Pemberton WA 6260 - Fax: 08 9776 1373

For ease of use customers may fill in their order requirements on this web page (which will calculate the freight and total payable automatically) and then print it using the print buttons at the top and bottom of the page. For security reasons the Credit Card & signature sections must be filled in manually after print.

Please fill in all sections. All personal details collected are kept strictly confidential, but are required to ensure swift delivery and to enable us to contact you as soon as possible should any difficulties arrive in the fullfilment of your order.

Personal/Delivery Details
Name:
Address:
City/ Town:
State:
Post Code:
Phone:
Email:

Credit Card Details
Type of Card:	Bankcard Mastercard Visa
Name on Card:
Card Number:
Expiry:
Signature	______________________________

Order Details
Code	Description	Year	Qty	Price	Total Price
Bottles
WINE1	Pemberley Sauvignon Blanc	2005		19.00
WINE2	Pemberley Sauvignon Blanc Semillon	2005		14.00
WINE3	Pemberley Merlot	2003		18.00
WINE4	Pemberley Shiraz	2003		18.00
WINE5	Cable Beach Sunset Sauvignon Blanc Semillon	2005		14.00
WINE6	Stairway to the Moon Merlot	2003		18.00
WINE7	Kimberley Dawn Rose			11.00
WINE8	Pindan Shiraz	2003		18.00
WINE9	Pemberley Pearl Chardonnay			14.00







Total number of bottles
Sub Total
Discount (10% discount for 12 bottle or over)
WINE TOTAL

Freight	Delivery To:
	Perth & South West WA - $6.00 first dozen (subsequent dozen $2) Elsewhere - $18 per dozen (1 - 12 bottles) OR call for current freight specials

GRAND TOTAL

Pemberley Farm Wines

Order Wine