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Club Membership Form

Fanatic's Name
   
Fanatic's Birthday
   
Shipping Address

Street Address Required.
We cannot ship to PO Boxes
   
   
         
State      
         
Zip    
   
DeliveryResidential
TypeBusiness
   
Other Mailing Address
   
   
         
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.”

 

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209.369.6805 - info@grandsamis.com