CLUB CASSEGRAIN APPLICATION FORM
This is a secure site for credit card transactions

BILLING/MEMBER DETAILS     
Name
    
Title
Address
Town
State
  
Post Code
  
Daytime Phone
Email
     Mobile Phone
      
 
$
PRICE

All
Red
Packs

All
White
Packs
Mixed Red & White
Packs
$ Total
Four Bottle Tasting Pack
A$67
$
Selection Dozen
A$180
$
All Occasions Dozen
A$129
$
Vintage Selection Dozen
A$204
$
International Selection 6-Pack
A$204
$
Quaffers Dozen
A$90
$
     
SUBTOTAL
$
SUBSIDISED FREIGHT CHARGES FOR DELIVERY WITHIN AUSTRALIA
Free to NSW, ACT, Victoria, Gold Coast, Brisbane & Adelaide; $10 Regional Qld, $5 Regional SA, $12 Perth, $20 Regional WA, $10 Tasmania, $30 NT
Select your region
        
Freight cost 
$
       
TOTAL PRICE INCLUDING FREIGHT      
Price of your order is
 $        
DELIVERY DETAILS        
Same as billing address
  
Type of address
 Home Business
Name
        
Address
  
Town
State
  
Post Code
  
Special Delivery Instructions  
 
   
PAYMENT DETAILS        
Credit Card
   Card Number
Name on Card
  
Expiry Date
 /

Please read this declaration: I authorise Cassegrain Wines to enrol me as a Club Cassegrain member and debit my credit card with the appropriate sums on dispatch of my wine. I have indicated my choice of wines on this enrolment form. I certify that I am over 18 years of age. For the purposes of compliance with the Liquor Act, I certify that my date of birth is

I agree I disagree

Delivery: Please allow up to 14 days for delivery although it will usually be faster. Offer subject to availability of stock; not available to persons under 18 years of age. Carrier acts as agent for the purchaser.

Cassegrain Wines Pty Ltd
ABN 40 095 429 744
Liquor License 24001801

Liquor Act 1982 - It is an offence to sell or supply to or obtain liquor on behalf of a person under the age of 18 years