I would like to join the wine club and agree to receive one dozen wines @ $120 per dozen two times a year. Please circle which club dozen you would like to receive. ALL WHITE ALL RED 6 RED/6 WHITE AS INDICATED IN THE ORDER FORM I understand that I can withdraw from the club at any time after the first year of membership by giving one months notice in writing. I am over 18 years of age. Signature: ________________________________________________

PAYMENT DETAILS —mail orders or wine club membership NAME:__________________________________________________ Address: _________________________________________________ _________________________________________________________

I wish to pay by MasterCard Bankcard Visa Amex TOTAL COST $120 per dozen Card number ______________________________________________________________ Cardholders name __________________________________________________________ Expiry date _________________________________________________________________ Daytime phone number _______________________________________________________ Signature__________________________________________________________________ Delivery address if different to mailing address. As we send via Australia Post , the box may be carded for pickup at the post office. There is no guaranteed door to door delivery