“Taste of the Vines”

Membership Information:                                                                             Today’s Date:                        

I/We would like to be member(s) of “Taste of the Vines” Wine Club of Eagle Ridge Vineyard

Club Member(s) First & Last Name(s):                                                                                                 

(Billing)Address:                                                                                                                               

City:                                                       State:                     Zip:                        Country:                

Primary email address:                                                       Alternate email:                                         

Phone Number:                                                      Alternate Number:                                                 

Birthdate(s): 

 Please ship my Wine Club Release to me          I will pick-up my Wine Club Release (within 2 weeks)     

Shipping Address:  Same as Billing or please complete the following

Street Address:                                                                                                                                             

City:                                                        State:               Zip:                Country:                             

Billing Information:   VISA             MasterCard       American Express            Discover

Name as it appears on card:                                                                                                             

Street Address:                                                                                                                              

City:                                                        State:                  Zip:              Country:                           

Credit Card Number:                                                               Exp:                   CSV:                          

*I understand that the club will automatically charge my credit card for each shipment, including taxes, shipping and any handling fees as appropriate.  It is my obligation to notify the club of any address or credit card information changes at least 14 days before club shipment.  Eagle Ridge Vineyard will not be responsible for shipping/return charges incurred due to misdirected shipments and reshipment.  Shipping will only be done to reciprocal states at the discretion of the winery.

*I certify that I am at least 21 years of age or older and an authorized signer on the above credit card.  In addition, I understand that upon delivery, an adult (21 years of age) signature will be required and that my package will not be left by the door.

* If you have requested to pick-up your wine club release, it will be held for two weeks from the date of notification.  If not picked up by that time, it will be shipped to you at your cost.

*I understand that membership in the Wine Club may be cancelled with a written 30-day notice prior to shipment of the wine.

*All information supplied on this application is held in strict confidence; we do not sell or give mailing information.

Today’s Date:                                        Signature: