Livery Membership Application

Membership Agreement Form

Please use this form to purchase and start your desired membership with The Livery Cigar Emporium located in downtown Fayetteville, NC.
Full Name (as shown on your ID)

First NameLast NameSuffix
Date Of Birth

MonthDayYear
Date
Please upload a photo of your state issued ID (front and back)

We will verify your age at the lounge as well.
Cancelof
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Please provide an emergency contact

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
ATTENTION:

Prior to purchasing your plan and signing this form, please read the membership agreement in it's entirety.

(This document will automatically download to your device when clicked).

Review Membership Agreement
I, the person filling out this form, do certify that I am of legal age (21 years or older), and that all information on this form is correct and true, to my knowledge. I understand that falsifying any of this information, or forging of signatures is illegal and punishable by law. I also understand that my age will be verified at the lounge, in which case if I am found to be under the legal age, I will not be granted access to the lounge.
By signing below, you agree to the following: I have carefully read and agree to the terms and policies of this membership agreement as it now exists and may be amended in the future. I am aware that direct violation of these rules may result in revocation of my membership.
Select your desired plan
Categories:All

All

General

Silver

Gold

Platinum

Lockers
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General

General Membership
Fee charged annually. Includes: General access to the lounge during normal business hours, by appointment, reservation, or invitation.

$25.00



Silver

Silver
Fee charged annually. Includes: General admission into the lounge and 10% discount on all shop purchases. House Cutter and $50 Gift card

$100.00



Gold

Gold
Fee charged annually. Includes: General admission into the lounge, 15% discount on all shop purchases, and invite to special events as space permits. House Cutter & Lighter. $100 Gift Card

$200.00



Platinum

Platinum
Fee charged annually. Includes: General admission into the lounge, 15% discount on all shop purchases, and VIP invite to special events. House Cutter, Lighter & 5 Count humidor. $150 Gift Card

$300.00



Lockers

Member Locker
Fee charged annually. Member lockers are be available for members at any level.

$350.00



Total

$0.00
Please insert your payment information below.

This form was created by The Livery Cigar Emporium, LLC. For questions about this form please contact:

The Livery Cigar Emporium
147 Maxwell Street
Fayetteville, NC 28301

Phone: (910) 705-6936
Email: info@liverycigar.com

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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Membership Agreement Form

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Payment Methods

Select your desired plan