Wine Order Form

Please fill in the below form to order wine. We will get back to you in 24hours, if not you are welcome to give us a call.
Phone +27 21 903 8203

First Name & Surname:

Cell Number:

Tel Number:

Email Address:

Fax:

Delivery Address:

Code:


  Amount of
bottles
Per
Bottle
(750ml)
QTY Cases Per Case
(6)
Total:
           
Chenin Blanc 2010 - Promotion R 25.00 R 150.00
Sauvignon Blanc 2011 R 39.50 R 237.00
Marie Antoinette 2007 R 59.50 R 357.00
Marie Antoinette Premium 2008 R 85.00 R 510.00
Cabernet Sauvignon 2006 R 59.50 R 357.00
Cabernet Sauvignon Premium 2007 R 85.00 R 510.00
Shiraz 2006 - Promotion R 49.00 R 294.00
Shiraz Premium 2008 R 85.00 R 510.00

Delivery costs apply, please enquire.

   
To prevent web form hacking, please type the digits and letters you see in the image to the right, into the text field under the image.
Note that letters are case-sensitive.
Code Image - Please contact webmaster if you have problems seeing this image code

If you can't read the image, click here to load a new image.

 
   

 

Copyright Groenland | All Rights Reserved 2009 Business Solutions From Internet Technology