Club Membership Registration Form

Wine Club Membership Registration

Complete the form below to sign up for our membership service.
Name*

First NameLast Name
E-mail*
ADULT SIGNATURE REQUIRED

By law, in order to make your delivery, there must be an adult 21 years of age or older to sign for your wine shipment. If no one is available to be home to sign for your wine, we strongly suggest having your wine shipment sent to a business where an adult is available to sign.

NOTE: WE CANNOT SHIP TO P.O. BOXES
Billing Address:*

Street Address

Apt, Suite, etc.

CityState

Zip Code
Shipping Address (if different than billing):

Street Address

Apt, Suite, etc.

CityState

Zip Code
Are you shipping to a business?*
If YES
Company Name
Phone Number:*

Area CodePhone Number
Birth Date:*

MonthDayYear
I verify I'm 21 years of age or older

Bravino! Italian Wine Club (2 WHITES, 2 REDS)($160 for each three months)

Bravino! Italian Wine Club (REDS ONLY)($200 for each three months)

Bravino! Italian Wine Club (WHITES ONLY)($120 for each three months)

*It is FREE to sign up. Your card will be charged upon shipment.*
Where did you hear about us?*

By meeting Carly or TommasoA friend or colleagueGoogleFacebookInstagram
Wine Club Rules & Benefits
1. FREE to join. Shipping is complimentary.
2. No commitment or cancelation fees. Skip a month or cancel anytime. (If so, you must let us know 1 week before we ship the wine)
3. Shipments include 4 bottles of wine shipped quarterly in the months of March, June, September and December
4. Re-order wines from previous shipment and get 20% off! (Minimum 3 bottles)
5. Membership is available to anyone 21 years old of age or older.
6. By law, someone 21 years of age or older must sign for the wine upon delivery. Therefore, we strongly recommend shipping to an address where someone is available to sign, such as a business.
7. We cannot ship to Utah or Mississippi for the time being.
I have read, understood, and accepted the rules for membership.
Privacy Policy
The security of your sensitive information in important to us. When you enter sensitive information such as a credit card number on our order forms, we encrypt that information using secure socket layer technology
I have read, understood, and accepted the PRIVACY POLICY for membership.
Thank you!
By submitting this application you are joining Bravino! Italian Wine Club.
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Wine Club Membership Registration