Wine Club CLUB MEMBER DETAILS Items marked with an asterisk (*) are required. FIRST NAME (*) Invalid Input LAST NAME (*) Invalid Input EMAIL (*) Invalid Input PHONE (format: 999-999-9999) (*) Invalid Input BIRTHDATE (format: mm/dd/yyyy) (*) Invalid Input CLUB SELECTION Select the number of bottles you wish to receive with each shipment from the list below (*) --------Receive ONE bottle each of TWO different winesReceive TWO bottles each of TWO different winesReceive THREE bottles each of TWO different winesReceive a mixed case Invalid Input SPECIAL REQUESTS Invalid Input This is a gift Invalid Input END DATE OF GIFT - if applicable (format: mm/dd/yyyy) Invalid Input GIFT IS FROM Invalid Input CREDIT CARD & CARDHOLDER CARD TYPE (*) American ExpressDiscoverMastercardVisa Invalid Input NAME ON CARD (*) Invalid Input CARD NUMBER (*) Invalid Input EXPIRY (format: mm/yy) (*) Invalid Input CREDIT CARD SECURITY CODE (*) Invalid Input ADDRESS 1 (*) Invalid Input ADDRESS 2 Invalid Input CITY (*) Invalid Input Choose from the menu (*) --------AlaskaArizonaCaliforniaColoradoDistrict of ColumbiaFloridaMichiganNevadaNew HampshireNorth CarolinaNorth DakotaOhioOregonRhode IslandSouth CarolinaVermontVirginiaWashingtonWest VirginiaWyoming Invalid Input ZIP (*) Invalid Input PHONE (format: 999-999-9999) (*) Invalid Input SHIPPING INFO (NO P.O. Boxes! If shipping to a business, please indicate business name) Ship to the Cardholder's address Invalid Input I would like to pick up my order at the winery Invalid Input FIRST NAME Invalid Input LAST NAME Invalid Input ADDRESS 1 Invalid Input ADDRESS 2 Invalid Input CITY Invalid Input Select State --------AlaskaArizonaCaliforniaColoradoDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIowaLouisianaMichiganMinnesotaMontanaNebraskaNevadaNew HampshireNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOregonSouth DakotaTennesseeTexasVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Invalid Input ZIP Invalid Input PHONE (format: 999-999-9999) Invalid Input (*) I UNDERSTAND AND AGREE TO THE FOLLOWING TERMS: Invalid Input Deliveries must be signed by an adult 21 years of age or older. NOTE: Three (3) Wine Club shipments are required prior to membership cancellation. A fee of $45 will be charged to accounts cancelled before minimum purchase is fulfilled. Cancellations must be received at least 15 days in advance of next shipment you do not want to receive. Payments will be processed before shipping. Orders scheduled for pick up left for more than 30 days will be shipped at club member expense, or if undeliverable, restocked for 15% fee. Discount is for cost of goods only. CA orders subject to CA sales tax. Other states may require us to charge sales tax. Shipping is restricted to the following states, and are subject to change: AK, AZ, CA, CO, DC, FL, GA, HI, ID, IL, IA, KS, LA, MI, MN, MO, NE, NV, NH, NM, NY, NC, ND, OH, OR, RI, SC, TX, VT, VA, WA, WV, WI, WY. Terms of agreement are subject to change. Wine substitutions may be made when availability is limited. Deliveries must be signed for by an adult 21 years of age or older. Refresh Image Invalid Input
