Full Name:
Phone Number:
Recipient's email:
Wine type:	please select... Red/Red Red/White White/White
Name on Card:
Card #:
Card expiration:	01 - January 02 - February 03 - March 04 - April 05 - May 06 - June 07 - July 08 - August 09 - September 10 - October 11 - November 12 - December 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
CVV
By signing the above you are allowing Winslow's Wine Cafe to debit your credit card for the amount of one month wine club membership ($60) through the length of the membership. The debit will take place on or near the 1st of each month, when the selections become available. By law only a person 21 years of age or older can be a wine club member or pick up the monthly selections.