Join Our Wine Club

(Bold/Red must be completed)

	Member/Billing Information
Name:
Email:
Phone:
Street Address 1:
Street Address 2:
City:
State:
Zip:
Birthdate:	,

	Shipping nformation
Ship to:
Name:
Email:
Phone:
Street Address 1:
Street Address 2:
City:
State:
Zip:
Shipping Method:
Type of Address:	Note: Federal law requires that wine shipments to a residence be signed for by an adult or be sent to a business address.


	Gift Information (Fill out only if sending Club Membership as a gift)
Gift Recipient:
How Long?:	1 Year Ongoing
Email:
Phone:
Street Address 1:
Street Address 2:
City:
State:
Zip:
Birthdate:	, (required if gift)

	Wine Club Options
Club Type:

	Credit Card Information
Card Type:
Name on Card:
Card Number:	(number only no dashs)
Expiration Date:

Comments
	I understand that twice a year I will receive a shipment of Cardwell Hill wine at the shipping address above. The wines and shipping charges are billed directly to my credit card. I also know I am obligated to at least two shipments but after that I may cancel my membership at any time with thirty days written notice by letter or email. I agree I disagree



	Copyright 2005, Cardwell Hill Cellars

Member/Billing Information