CLUB *

SELECT CLUB

4 CLUB

6 CLUB

12 CLUB

GROWLER CLUB (Refill by Appointment)

ADDITIONAL INFO

WILL CALL: Check box if you would like to pick up your shipments at the winery.

GIFT: Check box if this is a gift membership. Length of gift: Minimum of1 year (4 shipments)

SHIPPING ADDRESS *

We require a daytime address where a recipient who is 21 years of age or older will sign for shipments. Sorry, we cannot deliver to P.O. Boxes.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

BILLING ADDRESS *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

PAYMENT INFORMATION *

VISA

Master Card

AMEX

DISCOVER

Name on Card *

First Name

Last Name

Your card will charged when wine allotment is released *

Wine will be billed directly to your credit card when wine allotment is released. I understand that I may cancel my membership at any time after the first shipment without further obligation except for wine shipped prior to Gibson Wine Company's receipt of my notice. I am also aware that I am responsible for notifying Gibson Wine Company of any address changes before wine is shipped. Extra charges incurred for misdirected wines will be the customer's responsibility. A $50 cancellation fee will be applied and charged.

I UNDERSTAND