To: Pipestone Vineyards Wine Club · 2040 Niderer Rd. Paso Robles CA 93446 USA
Fax: 805-227-6383Voice: 805-227-6385
Wine Club Membership Application
Member Name
Mailing Address (must match credit card billing address)
Shipping Address Same as Mailing Address
Note: we are permitted to ship only to the following States: CA, CO, ID, IL, IA, MN, MO, NE, NM, OR, WA, and WI. These laws are changing, so ask if your state is not listed. Shipping charges will be added to billing.
Desired Membership Level? Gold Jade
Is this a gift? Yes No Will call? Yes No
Special Instructions
Home PhoneWork Phone
Email Address
Visa/Master Card Number
CVV/CID Code (3 digits on back of card)
Expiration Date
Name as it appears on card
Signature
By signing this membership application, I certify that I am AT LEAST 21 Years old. If this is a gift membership, recipient must also be at least 21 years old. Adult signature will be required upon receipt of shipment.
Please send or fax this membership application to:
Pipestone Vineyards Wine Club
2040 Niderer Rd. Paso Robles CA 93446 USA
Fax: 805-227-6383 Voice: 805-227-6385