Weisinger's of Ashland Winery

WINE CLUB APPLICATION

Number of Bottles per Shipment:
RED WINE CLUB:
2 bottles 3 bottles 6 bottles	(6 shipments per year)
	(6 shipments per year)

WHITE WINE CLUB:
3 bottles 6 bottles 12 bottles	(3 shipments per year)


SHIPPING INFORMATION:
I will pick up my shipments at Weisinger's Winery
NOTE: Legally, wine shipments require an adult (over 21) signature. You may want to consider shipping to your business address to accomodate this.
*NAME:
NAME OF SPOUSE/SIGNIFICANT OTHER:
(if applicable)
*BILLING/HOME ADDRESS:
(if different from shipping)
*CITY:
*STATE:
*ZIP:
SHIPPING NAME/BUSINESS:
SHIPPING ADDRESS:
(no P.O. BOX please)
SHIP CITY:
SHIP STATE:
SHIP ZIP:
*DAYTIME PHONE:
EVENING/HOME PHONE:
*EMAIL:
(Please include an email address if you have one. We will use it for emailing shipping information and will not be shared outside of Weisinger's Winery.

PAYMENT INFORMATION:
CREDIT CARD TYPE:	VISA MASTERCARD
CARD NUMBER:
EXPIRATION DATE (mo/yr):
NAME ON CARD:
CVV NUMBER:
ADDITIONAL NOTES:
FOR YOUR SAFETY WE USE A SECURE CERTIFICATE. YOUR INFORMATION IS ENCRYPTED AND PRIVATE.

PLEASE SELECT THE SUBMIT BUTTON ONCE BELOW TO PROCESS

THANK YOU AND WELCOME!

1.800.551.WINE