Eagle Creek Wine Club - Registration Form

Name

Phone

Cell

E-mail

Shipping Address

City

State

Zip

(Business Address is our first choice) Shipments of wine require a signature of a person 21 years or older at delivery.

Billing Address

City

State

Zip

Credit Card Information:

Acct#:

Exp. Date:

Vcode:

As a member of Eagle Creek Wine Club, I agree that wine will be shipped twice a year and my credit card will be billed for the membership wine cost plus shipping and sales tax where applicable. Membership may be canceled at any time after initial shipment. Notification required via Facsimile, mail or email. We accept Visa, Mastercard, Discover and American Express.

Signature:

Date:

Please call, fax or mail this form to: Eagle Creek Winery
10037 Eagle Creek Rd.
Leavnworth, WA 98826
Phone (509) 548-7668
Fax (509) 548-2062
E-mail:info@eaglecreekwinery.com

$55 - 3 bottle shipment
$60 - 3 bottle shipment (all reds desired)
$100 - 6 bottle shipment
$120 - 6 bottle shipment (all reds desired)