Order Form

Orders are for cases of 12 wines. Pengally Lane Wines will contact you by telephone to confim the final price for your delivered order and payment details.

Contact Information

Name *

Name of the person placing the order.

Phone Number *

Contact telephone number.

Email Address *

Billing Address

Address *

Number and street name / PO Box.

Town/Suburb *

Town or suburb name.

State * - Select -ACTNSWNTQLDSATasVicWA

We are unable to accept orders from outside of Australia.

Postcode *

Delivery Address

Copy from Billing Address

Name *

Name of the person the order is being sent to.

Address *

Number and street name / PO Box.

Town/Suburb *

Town or suburb name.

State * - Select -ACTNSWNTQLDSATasVicWA

Australian state. We are unable to deliver wine outside of Australia.

Postcode *

Order

Qty	Wine	Unit Price	Total
	Sangiovese
	Wooded Chardonnay
	Cabernet Sauvignon
	Home Block Shiraz
	Malbec
	Merlot
	Sauvignon Blanc
	VP Fortified Shiraz
	Total

Warning: Under the Liquor Reform Act 1998 it is an offence to supply alcohol to a person under the age of 18 years (penalty exceeds $6000) and it is an offence for a person under the age of 18 years to purchase or receive liquor (penalty exceeds $500). At the time of delivery the person receiving the goods must provide satisfactory evidence of proof of age if requested. Pengally Lane Wines may refuse to deliver the wine if proof of age is not provided.

Once you have placed your order we will contact you to arrange payment.