SINCLAIR WINES |
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| Please print this form and fax, mail or call us giving your order selection. |
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| Name: ___________________________________ Address: ________________________________ _______________________________________________________________Post Code:_________ Phone: (W)_______________________________(H)_____________________________________ Fax: __________________________ E-mail: ____________________________________________ IMPORTANT! Australia Post will not call before delivery. Please provide delivery instructions. e.g. Front porch or, best of all, your place of work. If there is nowhere safe to leave your wine if delivery address is unattended put “SIGNATURE REQUIRED”. Delivery is on receipt of payment by Direct Debit, Visa/Master Card or Cleared Cheque. Circle Payment Option: Cheque Mastercard Visa Direct Deposit Sinclair Wines Banking Details: Commonwealth - BSB: 066 147 - Account: 10154510 Card Number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Expiry Date: _ _ / _ _ Card Holder: ______________________________________________________________________ I certify that I am at least 18 years of age. Signature: _________________________________________Date:
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