Membership Form

MEMBER INFORMATION:

NAME ON MEMBERSHIP:
NAME OF PERSON(S) WHOM YOU GIVE AUTHORIZATION TO PICK UP YOUR SHIPMENTS (IF ANY): This field is required
ADDRESS:
CITY: This field is required
STATE:
ZIP:
PHONE:
ALTERNATE PHONE:
EMAIL:
ALTERNATE EMAIL:
I WILL PICK UP MY WINE AT THE TASTING ROOM
SHIP MY WINES AND CHARGE MY CARD FOR SHIPPING EXPENSES
- BUSINESS RESIDENCE
SHIPPING ADDRESS:
CITY:
STATE:
ZIP:
I WAS REFERRED BY:
SPECIAL REQUESTS:
FAMILY WINE CLUB: OUR TRADITIONAL WINE CLUB

Red WINES ONLY PLEASE

WHITE WINES ONLY PLEASE
I have read and agree to the above for membership in Carvalho Family Wine Club. I agree to accept four bottles of wine four times a year (twelve month period). I authorize Carvalho Family Winery to use my credit card for this purpose until written notice for cancellation of my Family Club Membership has been received. If wine is shipped and returned for refusal or non-delivery there will be additional handling costs that will be charged to my credit card. If I do not pick up my wines within four (4) weeks of notification, Carvalho Family Winery may ship it to me and charge my card for the shipping/ handling costs.
CARDHOLDER SIGNATURE:
DATE:
CREDIT CARD#:
EXPIRATION DATE:
SECURITY NUMBER:

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