| Shipping and Recipient Information |
Billing Information |
| Check One: |
Home Address Business Address Gift |
(if different from shipping information) |
| Name: |
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Name: |
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| (Must be identical to the name on the credit card) |
| Street Address: |
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Street Address: |
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| City: |
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City: |
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| State: |
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State: |
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| Zip: |
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Zip: |
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| E-mail: |
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E-mail: |
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| Tel: |
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Tel: |
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Note: Federal law requires that wine shipments to a residence be signed for by an adult or be sent to a business address. We are only able to ship to these states: AK, CO, FL, IL, IA, MN, MS, NM, OH, OR, TX, WA, and WV. |
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Two Bottle Membership (Maximum $75 plus shipping)
Four Bottle Membership (Maximum $150 plus shipping)
Six Bottle Membership (Maximum $225 plus shipping) |
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| Please charge to: |
Visa MasterCard
Credit Card #: Exp. (mm/yy): |
Billing Info &
User Agreement: |
By submitting this form I agree to join the Dobbes Family Circle, that I and the recipient are at least 21 years of age, and that my credit card will be billed four times a year just prior to receiving my wine. I can cancel at any time after my first shipment with 30 days notice.
I Agree |
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