Fields marked with a * must be filled in.
PLEASE PROVIDE US WITH ALL YOUR PERSONAL DETAILS:
First Name:
*
Surname:
*
Telephone:
*
Mobile:
Fax:
E-Mail Address:
*
Delivery Address:
Postal Address:
ORDER DETAILS
WINE
YEAR
PACKAGING
PRICE/Case
PRICE/Bottle
QTY
Value
Cabernet Sauvignon
2003
bottle( 750ml) x 6
R 480
R 80
R
Cabernet Sauvignon
2004
bottle( 750ml) x 6
R 420
R 70
R
Cabernet Sauvignon
2007
bottle( 750ml) x 6
R 360
R 60
R
Shiraz
2004
bottle( 750ml) x 6
R 420
R 70
R
Shiraz
2005
bottle( 750ml) x 6
R 360
R 60
R
Full Circle
(SOLD OUT)
bottle( 750ml) x 6
R 720
R 120
R
Vine Valley
2004
bottle( 750ml) x 6
R 540
R 90
R
Vine Valley
2006
bottle( 750ml) x 6
R 450
R 75
R
Port
2006
bottle( 375ml) x 6
R 450
R 75
R
Port
2007
bottle( 375ml) x 6
R 450
R 75
R
TOTAL VALUE
R
6 Bottles per case. Prices are per case, including VAT Please submit the order form to JS Wines in order to finalise the DELIVERY COST whereafter the TOTAL AMOUNT can be finalised and payment can be effected.
