Wine & Brandy Order Form
Contact Details
First Name:
Last Name:
Company:
Email Address:
Telephone (Office):
Telephone (Home):
Cellular:
Address:
Wine & Brandy Order list
Wine
Year
Quantity
Cabernet Sauvignon :
2004
(750 ml Bottle)
Cabernet Sauvignon :
2005
(750 ml Bottle)
Requested Date of Delivery :
d
/
m
/
y
Port
Quantity
Port :
(750 ml Bottle)
Requested Date of Delivery :
d
/
m
/
y
Grappa
Quantity
Upland Grappa :
(375 ml Bottle)
Requested Date of Delivery :
d
/
m
/
y
Extra Note:
Brandy Order list
Brandy
Quantity
Pure Pot-still Brandy :
(750 ml Bottle)
Brandy (Carafe in wooden box) :
(750 ml Bottle)
Brandy
Quantity
Guinevere Cask Strength Brandy :
(375 ml Bottle)
Reqested Date of Delivery :
d
/
m
/
y
Extra Note:
Fax this form off to: +27-21-873-5724
