Cellar Club

Enrollment

Membership Level

Billing Information
Name
Company
Address
City
State
Zip Code
Phone Number
Email
Card Type
Credit Card Number	(digits only)
Expiration Date	(ex. 07/2010)
3 or 4 digit Security Code
	I am 21 yrs old or older.
Birth Date	(ex. 07/29/2010 )

Shipping Information \| Copy Billing Information
Is This For Pickup?	Yes No
Name
Company
Address
City
State
Zip Code
Phone Number

Other Options
Where did you hear about us?
TERMS AND CONDITIONS: There is no fee to join the wine club. You will receive four shipments annually and must cancel 30 days prior to the next shipment. You will be notified by email of forthcoming shipments. It is the member’s responsibility to notify us of any address or credit card changes in advance of shipment. Once processed, wine club shipments are non-refundable. Shipping charges and sales tax apply.