WINE CLUB SIGN-UP FORM Name(required) Address, City, Postal Code Email(required) Phone Number(required) Birth Date(required) Wine preferences – Please list 2-4 favored varietals (Shiraz, Merlot, Chardonnay, Pinot Grigio, etc) 8 BOTTLE MONTHLY SUBSCRIPTION LEVEL(required) Gold $199 Silver $149 Bronze $99 WINE PACKAGE TYPE Reds Whites Mixed Case – Red, White, Pink Delivery Option – Delivery is currently only available in PortCoquitlam 1st Monday of the Month 1st Saturday of the month I prefer to pick-up at the store 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 Send Δ Share this:TwitterFacebookLike this:Like Loading...