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Order Form

To place an order, please fill in your details in the order form. You can print out the order form (click here to download order form) and fax to Brookhampton Estate on +61 8 9731 0500 or simply submit your completed order online. We will contact you with telephone call to confirm payment details before dispatch.

Customer Details
First Name * :
Last Name * :
Address * :
 
Postcode * :
Home Phone Number :
Business Phone Number * :
Fax :
Email Address :
Special Delivery Instructions :

 
Order Details
Wines Available
Bottle Price
Number of Bottles
Case Price
Number of Cases
  
Total
2001 Chardonnay
$16.00
$192.00
 
$
2001 Sauvignon Blanc
$16.00
$192.00
 
$
2001 Shiraz (Silver medal)
$18.00
$216.00
 
$
2001 Cabernet Sauvignon
$18.00
$216.00
 
$
2001 Mixed(6xWhite & 6xRed)
$17.00
$204.00
 
$
Gift pack (Any 2 wines in premium carry pack)
$40.00
N/A
 
$
2002 Shiraz
$18.00
$216.00
 
$
2002 Cabernet Merlot
$18.00
$216.00
 
$
 
 
Sub Total
  
$
Plus Freight per case (see note bellow)
 
 
 
$  
 
 

Total

 

  

$

 

Freight charges per case

Perth Metro $5
WA Country $10
Interstate $20