Print this order form and fax to +61 (0) 3 5942 7583 or mail with payment to

Toomah Wines 635 Toomuc Valley Road, Pakenham , Victoria 3810

Name

Address

Melways Reference

Delivery instructions

Telephone:

After Hours

Business Hours

Mobile

Facsimile

Toomah Wines  A.B.N 37-678-945-183

Telephone/Facsimile: +61 (0) 3 5942 7583 Mobile: +61 (0) 408 538 005

All prices in Australian Dollars and accurate as of August 2006.

Vintage/Variety

Quantity

Price per bottle

Total

Sauvignon Blanc 2003

$25

Pinot Noir 2001

$25

Cabernets 2001

$25

Sub Total

Discount for half dozen 10%

Discount for dozen (case) 15%

Delivery (Price on application)

TOTAL $

Payment Details

Please phone or fax Michelle on +61 (0) 3 5942 7583 to confirm payment and delivery.

Credit Card Details: Number#

Expiry date:                                            VISA    MASTERCARD    AMEX

 Or direct deposit, please contact us.

Thank-you.