New Wine Club Member

New Wine Club Member Form

Please fill out the following information so we can get your membership started. Once this is completed, you will be directed to our online store where you will purchase your first Wine Club allocation. Your purchase will determine your Club membership level – Mixed Club, Big Reds Club, or Winemaker’s Select Club.

Member Name

First Name

Last Name

Billing Name

If different than Member Name

First Name

Last Name

Billing Address

If PO Box, please provide shipping address below.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Additional Name on Account

This person will be entitled to use benefits and pickup wine shipments

First Name

Last Name

Primary Phone

(###)

###

####

Secondary Phone

(###)

###

####

Primary Email

This email will be used for notifications and will be the user name for your online store account.

Secondary Email

Member’s Birth Date

YYYY

Shipping is the same as billing

Shipping Name

First Name

Last Name

Shipping Address

If different than Billing Address. No PO Boxes are not valid for wine shipments.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Delivery Preference

Your first allocation will be shipped when you purchase it online. The options below will be for the automatic allocations once membership is completed.

Will Call – you will have 30 days to pick up your wines from the winery before it is shipped to your address provided. (Note: shipping fee will apply if we ship)

Shipping – Wine will be shipped to the address provided. Please consider shipping to a business address as someone 21 years of age or over must be available to sign for the package at time of delivery. Shipping fee will be included with Club billing.

Additional Information/Comments