MembershipRevisions

Inner Circle Wine Club Membership Revisions

* Indicates required field

Name *

First

Last

Club Member ID # *

Phone Number *

Date *

Email *

Change To Club

Previous Club - select one *

Club Upgrade *

New Club - select one *

Change to Wine Selection (Type)

Previous Type - select one *

New Type - select one *

Change to Address

New Billing Address *

Line 1

Line 2

City

State

Zip Code

Country

New Shipping Address - if different *

Line 1

Line 2

City

State

Zip Code

Country

Change to Credit Card

If you need to request a change to your credit card information, please check this box. Our Club Manager will follow up with the phone number on file. *

Check to change credit card information

Other Information/Notes *

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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