Memberships

Member Information

Name: *

Spouse/Partner:

Organization:

Billing Address: *

Address Line 1

Address Line 2

City

State

ZIP

Phone: *

E-mail: *

Referred by:

Join the Club *

Value Wine Club (2 Bottles per Month) $39.99
Fine Wine Club (1 Bottle per Month) $39.99
Premium Wine Club (1 Bottle per Month) $70 - $150
Beer Club (Monthly) $39.99
Alternate Wine/Beer Club (Monthly) $39.99
Scotch Club (Every Other Month) $70 - $150
Specialty Club (Monthly)

Value Wine Club Options:

Fine Wine Club Options:

Premium Wine Club Options:

Alternate Wine/Beer Club Options:

Specialty Club Options:

Reserve a Locker (Members Only):

Small Locker ($225/year)
Large Locker ($325/year)
No Locker at This Time

Name on Locker:

Delivery Information: *

Pickup
Locker
Delivery to Home or Office

Delivery Address:

Address Line 1

Address Line 2

City

State

ZIP

Building # / Door Code / Special Instructions:

Recurring Payment Authorization - Check Box to Authorize: *

"I authorize Cellar & Loft to charge my credit card listed below for the payment of my Club and/or Locker Fees, as indicated above."

Primary Card: *

Visa
MasterCard
Amex
Discover

Primary Card Cardholder Name: *

Primary Card #: *

Primary Card Exp. Date: *

Primary Card CCV #: *

Secondary Card:

Visa
MasterCard
Amex
Discover

Secondary Card Cardholder Name:

Secondary Card #:

Secondary Card Exp. Date:

Secondary Card CCV #:

Membership Terms - Check Box to Indicate Your Agreement with the Following Terms: *

This is a 3 Month Minimum Membership, with 30 Days' Notice Required to Discontinue Membership.

Digital Signature (Please type your Name): *

Today's Date: *

Member Information

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