Goldschmidt Vineyards Wine Club Form

MEMBER INFORMATION

Select Membership Type

Member/Self
Gift Membership. (Purchaser to complete CARDHOLDER section below)

Select Membership Level

NAVIGATOR MIXED - Shipments: white + red, 6 btls, 4/yr, less 20% | Everyday price less 10% btl; 20% case
NAVIGATOR RED- Shipments: red only; 6 btls, 4/yr, less 20%. Everyday Price: less 10% btl; 20% case
TRAVELER MIXED - Shipments: white + red; 12 btls, 4/yr, less 25% | Everyday Price: less 15% btl; 25% case
TRAVELER RED- Shipments: red only; 12 btls, 4/yr, less 25% | Everyday Price: less 15% btl; 25% case

Member Name *

First

Last

Cardholder Name *

First

Last

(Authorized Purchaser of Gift Membership)

Member Email 1 *

Member Email 2 (optional)

Cardholder Email

(email for purchaser of gift membership)

Mobile Phone (required) *

Daytime Phone (required) *

Date Of Birth (must be 21+ years to join)

SHIPPING INFORMATION

Shipping Address *

Address Line 1

Address Line 2

City

State

Zip Code

Shipping Instructions (optional)

BILLING INFORMATION

Billing Address *

Same as Shipping
Other. Complete Section Below

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Credit Card Type

Visa/MC
Amex

Visa/ Mastercard

American Express

Expiry Date Month/Year

XX / XX

CVV *

Terms of Membership *

I Agree

Submitting this membership form acknowledges I am: 21+ years of age; an authorized purchaser; will purchase a minimum of two (2) club shipments per calendar year with a limit of one (1) suspended/held shipment per calendar year allowed; will notify Goldschmidt Vineyards in writing (email) of shipping and billing changes no later than 14 business days prior to club shipment release date; consent to receiving email communications regarding my club status and member offers; agreeing to all terms as outlined. Questions? Contact Wine Club Manager, Karen Clarke at karen@goldschmidtvineyards.com or call (707) 473-9262. Rev. 03/22