Wine Club Order Form
First Name: Last Name:
Email: Phone:
Full Address: Member Code:
   

Order
Sauvignon Blanc Maiden Vintage 2007 (Magnum) Quantity:
Sauvignon Blanc 2008 Quantity:
The Chardonnay/Semillon Maiden Vintage 2008 blend Quantity:
Cabernet Sauvignon Maiden Vintage 2007 Quantity:
Shiraz Maiden Vintage 2007 Quantity:

Delivery Details
Delivery Address: City/Province/State:
Postal Code:
Country
Special Delivery Instructions:


Postal Details
Postal Address: City:
Province/State:
Postal Code:

 

Contact Details
Phone: Fax:
Mobile: E-mail:

 

Payment Details
Type: Credit Card Number:
Expiry Date: CVC Number:


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Pricing: All prices include Value Added Tax (VAT), but excludes delivery charges (where applicable), which are calculated at point of sale. Prices quoted per case as indicated.

Delivery: Subject to availability and receipt of payment. Delivery will be made to your door at the address specified on your order/application form. Please indicate your postal code when entering your delivery address. For a quote on domestic and international destinations please contact jethro@benguelacove.co.za or 021 683 9061
 

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