Goldschmidt Vineyards Wine Club Form
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2022-03-14T12:33:24-07:00
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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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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
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