The Yileena Park Winery of Yarra Valley

Wine Order Form

Please make your selection below. You may then send it to us by clicking the SEND ORDER button or by printing the form and mailing it to us. We will contact you regarding payment and shipping of your order.

Your Name: (REQUIRED)

Your Company:

Your Address:

Your Phone (including Area Code) (at least one required):
Voice:	FAX:	Mobile:

Your E-mail Address (REQUIRED)

Note: Be sure to use your complete email address
(e.g., username@domain.com.au)

Orders (Please enter quantities you would like):
If you want more than 10 cases, please call or e-mail us

Item (Click for description)	Number bottles	Bottle Price	Number cases	Case Price	Total
		$		$	$
		$		$	$
		$		$	$
		$		$	$
		$		$	$

You have ordered		bottles and		cases for	$
Enter comments or special instructions here

There are 12 bottles in a case, and we will apply a discount of 10% on one or more cases ordered.
The minimum order for shipping is 3 bottles.

Please enter the letters shown in the image below in the box to its right.
This will help eliminate junk e-mail to us.
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You may use the "Print Form" button above to print a copy to mail or FAX to us if you wish.

We will contact you regarding your order on this form.