Name *

First Name

Last Name

Phone

(###)

###

####

Birth Date *

You must be 21 or older*

MM

DD

YYYY

Billing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Shipping Address

Leave blank if same as billing

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Payment Information *

VISA

Master Card

Amex

Discover

Name on Card

First Name

Last Name

Shipments returned due to incorrect address or undeliverable will be destroyed. In addition, return freight charges will apply ___. Club options all include a mixed shipment of white and red wines. Member selected wines available at additional annual fee of $25. All members are provided priority options for events. All members receive prior selection on sale and limited release wines.

Check Agree or Disagree

Agree

Disagree

Acknowledgement of CCW Policy

I am at least 21 years of age and will provide an adult signature for all wine shipments Please Initial ____. My annual membership is for 3 shipments in February, May and October for all clubs. I agree wines MUST BE STORED at 62F plus or minus 2 degrees to insure the integrity of the wine. Transporting wine from the winery to my home could be protected with a Cottonwood insulate container. Please Initial ___ that you can meet these crucial storage and transportation temperature conditions. Shipments are processed the first week of each shipping month. I understand my credit card will automatically be charged prior to each wine shipment and I will be notified via email. Cancelling my membership regardless of reason, before I have met my yearly obligation, my credit card will be charged a $75 cancellation fee Please Initial ___.. Cancellation must be received via email 30 days prior to the next shipment. If I elected to pick up my order from the winery, my shipments must be picked up within a 30 day window. If not, my wine will be shipped and applicable shipping charges will be charged to my credit card Please Initial ___ Please note CCW cannot hold your shipment and cannot guarantee the wine mix that we shipped that period.

I acknowledge and agree to each listed policy above

I disagree to each listed policy above and do not want to join CCW wine club