Club Membership Form

Fanatic's Name
Fanatic's Birthday
Shipping Address
Street Address Required. We cannot ship to PO Boxes
City               State                 Zip         Delivery Residential Type Business
Other Mailing Address
City               State                 Zip
Contact Phone
Email Address
[we will notify you by email a week prior to wine being shipped]
Comments

We will contact you for your credit card number.

I understand that by completing this form I will become a fanatic member of Club Fanatics and I will receive all the benefits entitled to this membership. All member information will be kept in strict confidence. I can cancel at any time by sending a notice by fax 209.369.9832, email: info@grandsamis.com or mail to: Club Fanatic, P.O. Box 885, Victor, CA 95253-0885.

Great wine is meant to be shared with “great (fanatic) friends.”