PULPIT ROCK ESTATE WINES   PTY LTD     ABN 57 096 230 894


2877 WOMBEYAN CAVES ROAD, BULLIO, NSW, AUSTRALIA 2575

VIGNERON'S LICENCE NO - 2401 2963 . LICENCEE - A P MARTIN

WEB:        www.pulpitrockestate.com.au
EMAIL:     philip@pulpitrockestate.com.au
FAX:         +61(0) 2 4871 3003  
PHONE:    +61(0) 418 242 045
MAILING ADDRESS:    PO Box 871, Mittagong, NSW 2575, AUSTRALIA

ORDER FORM          RETURN BY FAX OR EMAIL       
 

 WINE
 VINTAGE
 B / CTN
 $ BOTT
 No BOTTLES
 $ TOTAL
 CHARDONNAY
2006
  6  
46
.
  
 CHARDONNAY
2007
  6  
40
.
  
 CHARDONNAY
2010
  6  
32
.
  
 PINOT NOIR
2005
  6  
46
.
  
 PINOT NOIR
2007
  6  
46
.
  
 PINOT NOIR
2008
  6  
42
.
  
 PINOT NOIR
2009
  6  
42
.
  
 FREIGHT   No charge: Sydney Metro, Illawarra, ACT, Hunter, S Highlands.    $
 TOTAL . . . .    $
 
 ORDER DETAILS             Your Signature will be required at Delivery          Proof of Age may be required.
 TODAY'S DATE .
 YOUR NAME .
 DELIVERY ADDRESS .
 POSTAL CODE .
 PHONE, FAX .
 EMAIL .
 
 PAYMENT DETAILS

I Agree to Pay the Amount of  $………………………………………………………..……………………………………... via

A - EFT Direct Credit to WESTPAC BANK .. BSB = 032 032   AC NO. = 258 360        

B - Please Debit Credit Card   VISA   MASTERCARD   BANKCARD  for The Above Amount.

Credit Card NUMBER                 
Credit Card EXPIRY DATE……………………………………………………………………………………………………...
Credit Card NAME [ON CARD]………………………………………………………………………………………………...

Signature…………………………………………………………………………………………………………………………..
  IMPORTANT NOTES
1 We shall phone to confirm your order and arrange delivery method and cost, upon receipt of your written order.
2 Orders should be in multiples of 6 bottles to ensure safe delivery in full cartons, except by special arrangement.
3 Orders cannot be accepted and delivery cannot be made to anyone under the age of 18 years under the NSW law.