Yes!  Sign me up for Stellar Cellar’s Monthly Wine Club… 
Drop off Completed Forms at Stellar Cellar or Fax to: 951.541.9675

 ___ Red Wines Only Club - $48 per month (2 bottles/month)
 ___ Variety Select Wine Club - $45 per month (2 bottles/month)
 ___ Collector’s Wine Club - $98 per month (2 bottles/month)

Club Member Info:

Name:_________________________________________________

Shipping Address Street:______________________________________________________________

City, State, Zip:______________________________________________________________________

Telephone (preferred) #:_________________________Email:__________________________________

Payment Information

Cardholder’s Name:____________________________________________

Credit Card Billing Address:_____________________________________________________________

City, State, Zip:_______________________________________________________________________

Payment Method:  Visa____  Mastercard ____

Credit Card Number:_____________________________________________________

Expires on:____/______   Verification #:_______ (3 digit number security number on the back of your card)

Authorization: By signing below, I authorize Stellar Cellar to bill my credit card for monthly wine club shipments on the first (1^st) of each month, including applicable tax and shipping costs.  I understand that I have one week to pick-up my shipment, and if it is not picked up within that week’s time, Stellar Cellar is authorized to ship to my shipping address above and charge applicable shipping charges to my credit card account.  I understand that it is my responsibility to notify Stellar Cellars if I wish to cancel my membership, and that the cancellation request must be received in writing by the 15^th of the month prior to the next wine club distribution.  I further understand that it is my responsibility to notify Stellar Cellar in writing of any changes to my email and mailing address and/or credit card information.  In signing this membership form, I represent to Stellar Cellar that I am at least 21 years of age, and that any person receiving a shipment by mail is also at least 21 years of age.  Adult signature is required at time of delivery and/or pick-up.

Signature: _____________________________________________  Date:______________________

Cancellation Policy: Membership may be cancelled at anytime. Cancellations must be received by the 15^th of the month to apply to the upcoming month's wine distribution .

****Stellar Cellar Use *********
Associate:__________________  Date:_________  Gift Membership:______ Processed:____________