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Cellar Club Member Information
Name:
Email:
Phone:
Street Address 1:
Street Address 2:
City:
State:
Zip:
Would you like to pick up your quarterly wine selection?
Please select your preference
Check One or More: Business Home Gift
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?:
Email:
Phone:
Street Address 1:
Street Address 2:
City:
State:
Zip:

Credit Card Information
Card Type:
Name on Card:
Card Number:
Expiration Date: ,
Date of Birth: ,

Comments:
Security Question: What if you had six apples and someone handed you a dozen more. How many would you have?
Enter number below:

By agreeing to become a member of the 'Melrose Club', I am at least 21 years of age and my credit card will be billed 4 times per year just prior to receiving my seasonal bottles; each billing not to exceed $55.00 to $65.00 PLUS SHIPPING for quarterly deliveries. I can cancel my membership at any time with 30 Day Written Notice after my first 2 shipments.

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