Wine Club (WC)² Signup Form

Membership Options:

 *Enthusiast Membership            Private Reserve Membership

MEMBERSHIP FORM

Today's Date:*      
Name:*        
Mailing Address:*        
City:*            State:*              ZIP:*       
Phone:*           Email: 

* Hold at winery for pickup or     Ship Via FEDEX

SHIP TO ADDRESS (if different)

Name: 
C/O:    
Street: 
City:         State:      Zip: 
Phone: 

I understand that every six months I will receive two bottles of Wineglass Cellars wine, appropriate to my membership level, at the shipping address above.  Each shipment will be billed directly to my credit card.  I will keep Wineglass updated on any address changes and agree I am responsible for shipping charges on misdirected shipments caused by address change.  I may cancel my membership at any time with 30 days written notice by letter, fax, or e-mail. I am at least 21 years of  age and ensure that someone at least 21 years of age will sign for the shipment at the delivery address.

We can ship to the following states only:  CA, CO, DC, ID, IL, IA, LA, MN, NE, NV, NM, ND, OR, WA, WI WY, WV

* I HAVE READ AND AGREE TO THE ABOVE CONDITIONS

You may enter your Credit Card Information, or if you prefer call 509-829-3011.

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#          Exp Date: 

* - Required Fields