Yorkville Cellars

MEMBERSHIP APPLICATION

Please accept my membership application to the Hi-Rollrs Wine Club of Yorkville Cellars. All information will be kept in strict confidence. I understand that my credit card will not be billed until the time of shipment.

Visa, MasterCard, American Express, and Discover cards are accepted. All transactions made through this site are encrypted and secure. However, if there is a concern about sending a credit card over the Internet, the order form details may be faxed, telephoned or mailed.

Billing Information: Note: (Date of Birth is included to comply with certain state regulations regarding alcohol control.)
First Name:
Last Name:
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Day phone:
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E-mail Address:
Date of Birth :
Credit Card Type:
Credit Card Number:
Credit Card Exp Date:
Shipping Information (leave blank if same):
First Name:
Last Name:
Street:
Street 2:
City:
State/Prov:
Zip/Postal Code:
Country:
Day phone:
Evening phone:
Comments:
I agree to JOIN! I certify that I am 21 years of age or older. I have read and understand the information regarding the Wine Club, and I agree to the terms. I understand that I may cancel at any time giving two weeks written notice but will be responsible for any wine shipped on the regular club sample program.
Thank you for joining! And Welcome - You're now a "Hi-Rollr"

Join our wine club and become a Hi-Rollr.