WINE CLUB SIGN-UP FORM

Name

Address, City, Postal Code

Phone Number

Birth Date (YYYY-MM-DD)

Wine preferences – Please list 2-4 favored varietals (Shiraz, Merlot, Chardonnay, Pinot Grigio, etc)

8 BOTTLE MONTHLY SUBSCRIPTION LEVEL

WINE PACKAGE TYPE

Delivery Option – Delivery is currently only available in PortCoquitlam

Other Details

Once you have signed up we will call you for your credit card information or if you prefer you may add the Wine Package you prefer to your cart on the webstore and pay for it there. Please call Scott with any questions 778-285-8512

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