Join Silvan Ridge's Wine Club

	Member Information
Check One:	Pick up at Vineyard Please Ship
Name:
Email:
Phone:
Street Address 1:
Street Address 2:
City:
State:
Zip:
Birthdate:	,
Check One or More:	Business Home 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?:	1 Year Ongoing
Email:
Phone:
Street Address 1:
Street Address 2:
City:
State:
Zip:
Birthdate:	,

	Wine Club Options
Club Type:

	Credit Card Information
Card Type:
Name on Card:
Card Number:
Expiration Date:

Comments
	By agreeing to become a member of the Silvan Ridge - Hinman Vineyards Wine Club', I am at least 21 years of age and my credit card will be billed up to 6 times per year just prior to receiving my bottles; each billing will be between $28.00 and $73.00 PLUS SHIPPING (depending upon which I club I join) for deliveries. I can cancel my membership at any time after I pay for my first shipment. I agree I disagree

Member Information