Inner Circle Wine Club Application

To request a printable application, please email our
Club Manager at [email protected]

* Indicates required field

Inner Circle Wine Club Selection (Choose One) *

Signature (2 bottles per quarter) Premier (4 bottles per quarter) Diamond (12 bottles per quarter)

Member Name *

First

Last

Date *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Date of Birth *

Shipping Information (if different from your mailing address): *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

I would like to have my order: *

If your wine shipment is to be picked up, we will hold it for 30 days. Your wine will automatically be shipped to the above address at that time. Federal law requires that all wine shipments be signed for by a person 21 years or older. A shipping charge is added to each shipment.

Name *

First

Last

Please do not use Auto-Fill when completing this section of the form.

Type your name here, as your electronic signature *

I authorize Dancing Dragonfly Winery to periodically charge my credit card for the cost of wine included in the quarterly Inner Circle Wine Club shipments. Each shipment will be charged separately. If shipped rather than picked up, it will include a shipping charge. Dancing Dragonfly Winery will only use the credit card information on this form for the purpose of paying for wine sent as a member of the Inner Circle Wine Club. Terms and conditions subject to change without notice.

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