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Name:
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Street (Delivery) Address:
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District:
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Town:
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Postal Code:
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Telephone:
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E-Mail Address (optional):
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Item
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Price
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Qty
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Total
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6 Bottles
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6 @ $18.00 = $108
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12 Bottles
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12 @ $16.50 = $198
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Freight & Packaging
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North Island:
Per 6 bottle Case $10
Per 12 bottle Case $15
South Island:
Per 6 bottle Case $12
Per 12 bottle Case $20
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TOTAL
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