Wine Club Application : Vino Bella Wine Club

Wine Club Application
Name: Last, First, Middle Initial *
Date of Birth: *
Address: *
City *
State *
Zip Code *
Contact Number *
Is this Home or Cell number? *	Home Cell
E-Mail Address *
Membership Level *
How did you hear about our Wine Club?
Terms and conditions:	By selecting submit on this form, I confirm that I am at least 21 years of age to purchase and receive alcoholic beverages. An adult signature will be required at delivery. Any misrepresentation of age will be prosecuted to the fullest extent of the law. Our memberships are month to month. Membership applies as soon as the Wine Club Application is submitted. Members that sign-up before the 15th of each month will receive that months wine selection, which will be available 5-7 business days after the 15th of that month. Members that sign-up after the 15th of each month will recieve the following month's wine, which will be available 5-7 buisiness days after the 1st of the following month. Each new member will receive their user name and password with-in 72 hours of membership. Members must give a 30-day notice to cancel membership. Cancellation prior to 30 days will result in a $35 early termination fee. Shipping and handling charges will apply when applicable. Terms and conditions are subject to change without notice. Current terms and conditions are always available on our website.

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