LODI WINE LOVER’S CLUB APPLICATION
FAX APPLICATION TO (209) 367-0737
You will receive (8) shipments of (2) bottles of wine per year. Your credit card will be charge $30 - $40 per shipment (plus shipping and handling at the time of shipment).
____ BECOME A MEMBER
____ SEND AS A GIFT MEMBERSHIP
NAME: ________________________________________________________________
MAILING ADDRESS: ____________________________________________________
CITY / STATE / ZIP: _____________________________________________________
DAYTIME PHONE: _______________________________________________________
EMAIL ADDRESS: ______________________________________________________
Shipping Information (if different from above. NO DELIVERY TO P.O. BOXES)
NAME: ________________________________________________________________
SHIPPING ADDRESS: ____________________________________________________
CITY / STATE / ZIP: _____________________________________________________
CREDIT CARD INFORMATION
CARDHOLDER’S NAME: _________________________________________________
CARD NUMBER: ________________________________________________________
EXP. DATE ___________________
____VISA ____MC ____AMEX
I certify that I am 21 years of age or older and I give permission to LODI WINE LOVER’S CLUB to charge my credit card for each shipment.
TODAY’S DATE: __________________________________
SIGNATURE: _____________________________________
Void where prohibited by law.