to sign up!

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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