Page 51 - Segreti Catalogue 2017 + Order Form

SEGRETI AUSTRALIA PTY LTD 1/12 Bird O’Passage Parade Scarborough, QLD, 4020
P (07) 3203 5222
F (07) 3203 4555
Email: segreti@bigpond.com
ORDER FORM
BILLING ADDRESS
SHIPPING ADDRESS
NAME: _________________________________________ ADDRESS: _____________________________________
_______________________________________________
SUBURB: _______________________________________ STATE: _____________ POST CODE: ___________
Same as Billing Address
NAME: _________________________________________ ADDRESS: _____________________________________
_______________________________________________
SUBURB: _______________________________________ STATE: _____________ POST CODE: ___________
MINIMUM ORDER $150 (Brisbane Metropolitan Areas)
Without exception, orders must be received by 11am Tuesday for same week delivery. Standard Courier rates may apply to lesser amounts and for delivery outside of Queensland.
PAYMENT INFORMATION
Cheque or money order enclosed (make payable to Segreti Australia Pty Ltd)
CREDIT CARD
Visa Master Card AMEX
Card Number
Exp. Date
/ CVV
(CVV is the 3 or 4 digit number on the back of the card in the white signature panel)
Signature: ______________________________
DIRECT DEBIT BANK DETAILS
Name of Bank_____________________________ BSB _____________ Account___________________
Please indicate the quantity required against the desired size/s.
GOURMET DIPS
CODE
PRODUCT
SIZE
QTY
SIZE
QTY
SGDGCHI
"Caution" Ghost Chilli Dip (VERY HOT)
150g
2kg
SGDGSAL
"Caution" Ghost Chilli Salsa (VERY HOT)
150g
2kg
SGDBLU
Blue Cheese, Pear & Walnut Dip
180g
2kg
SGDBRU
Bruschetta Mix
180g
2kg
SGDGAR
Roasted Garlic, Feta & Basil Pesto Dip
180g
2kg
SGDMUS
Smoked Mushroom & Feta Dip
180g
2kg
SGDPRA
Smoked Prawn Dip
180g
2kg
SGDSAL
Smoked Salmon & Dill Dip
180g
2kg
SGDTOM
Smoked Tomato Dip
180g
2kg
SGDBEAN
White Bean & Truffle Dip
180g
2kg
SGDTGRE
Green Olive Tapenade
180g
2kg
SEGRETI AUSTRALIA PTY LTD ORDER FORM as of 8/16/2016 Page 1 of 4