Stuart Cellars - Wine Club Application

STUART CELLARS
WINE CLUB APPLICATION

You have the option of emailing this form or filling it out, printing it, and mailing or faxing it to us.
Fax Number: (951) 693-2964 | 33515 Rancho California Road, Temecula, CA 92591

Member Name:
Spouse's Name (If Applicable):
Mailing Address:
City:
State:
Zip Code:
Date of Birth:

Will Call / Pick Up Option:	Do Not Ship - I will pick up each shipment from the Winery. Only select this option if you intend to visit the winery each time a new selection is released.
Shipping Address (if different):
City:
State:
Zip Code:

Phone Number:
Fax Number:
Email Address:

	If the Wine Club membership is a gift, enter the card member's information below:
Card Holder's Name:
Mailing Address:
City:
State:
Zip Code:
Gift Expires:	[No Date = Expires when cancelled]

Charge Card:
Card Number:
Expiration Date:

Who referred you to Our Club :
Name of Member/Associate or Other:

Membership Series:
Membership Types
Mixed:	Check this Box if you want us to ship you red & white wines.
Red Only:	Check this Box if you don't want us to ship you any white wines.
White Only:	Check this Box if you don't want us to ship you any red wines.

Special Instructions:	[Enter any special instructions or information that Stuart Cellars should know.]

By submitting this membership application, I certify that I am 21 years of age or older,
and I authorize Stuart Cellars to process all orders/shipments with the above credit card
and agree to pay the charges when billed (plus sales tax if shipped in California).

I understand and agree that if I wish to return the wine, I will pay all
shipping and handling charges incurred by Stuart Cellars.

I understand that there is NO Membership Fee required and
I can cancel at any time in writing after receiving two shipments.

I also understand that an adult signature will be required before
the shipping agent will release the shipment.

This is a secure form. However, if you are worried about interception,
consider filling it out online, printing, and faxing this application.

If this Wine Club Application is mailed or faxed to Stuart Cellars, please sign below certifying: I am 21 years of age or older and I authorize Stuart Cellars to process my order with the above credit card.

By:

Date: