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COMPASS CLUB SIGN UP FORM Anchor Club Waitlist Yes / No
3 Shipments per year of 2 bottles each. Average charges per shipment will be between $75-$95 which will include sales tax and shipping. **PLEASE PRINT CLEARLY**
BILLING INFORMATION: NAME: ADDRESS: CITY:
STATE:
ZIP CODE:
PHONE #:
(Home / Work / Cell / Other)
PHONE #:
(Home / Work / Cell / Other)
EMAIL: PICK UP AT THE WINERY? Yes / No
BIRTHDATE: _____/______/_______ (Month/
Date/
Year)
(Great option for Foxen locals to pickup within 1 month of the shipment date*)
IS THIS A GIFT? Yes / No
SHIPPING TO: Residential / Business
(If yes , # of shipments _____
(UPS requires an adult signature for delivery, we recommend
or unlimited_____)
shipping to a business address)
SHIPPING INFORMATION: o Please check here if your shipping address is the same as your billing address NAME: ADDRESS: CITY:
STATE:
PHONE #:
ZIP CODE: (Home / Work / Cell / Other)
We ship to the following states: AK,CA,CO,FL,GA,HI,ID,IA,IL,IN, KS,MD,ME,MI,MN,MO,MT,NC,NE,NH,NJ,NM,NV,NY,OH, OR,SC,TN,TX,VA,WA,Washington DC,WV,WI, WY
PAYMENT INFORMATION: CREDIT CARD #:
EXPIRATION:
(We accept Visa, MasterCard, American Express & Discover) Terms:
*
By signing this membership form, I certify that I am at least 21 years old I authorize Foxen Vineyard to automatically charge my credit card at the time of each shipment. Foxen Vineyard has the right to refuse membership or terminate membership at any time I understand that an adult over the age of 21 must sign for shipments at the time of delivery For pick up members, if your shipment is not picked up within 1 month of shipment date, your wine will be shipped and the shipping cost charged to your card
SIGNATURE: For Office Use Only: TR Initial: Date:
7600 FOXEN CANYON ROAD SANTA MARIA, CA 93454
DATE: VN: LW:
PHONE#: 805 937 4251
FAX#: 805 937 0415