Wine Club Sign-Up Form

Wine Club Sign-Up Form
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date

MonthDayYear
Date
Membership Level (Please choose 1)

Peloton (15% off)Tour of Mendocino (25% off)
Shipping Information (Please choose 1)

My shipping address is the same as the membership addressPlease use the address given belowPlease hold for local pickup
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

My Products

Wine club sign up form

$ Free

Total

$0.00

Credit Card

Apple Pay

Google Pay

Cash App Pay

Any messages or special instructions:
By clicking the SUBMIT button below, I authorize Cesar Toxqui Cellars to charge my credit card for wine and shipping charges. Also, I agree to be a wine club member for at least one year. By placing an order for an alcoholic beverage through our website, you formally represent that you are at least 21 years of age and that the intended recipient of the shipment is at least 21 years of age. Lastly, you agree with the privacy policy and terms and conditions.
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