
Different than the Rest
Wine Club Application
(Please print this page, fill out, and mail or fax it to us)
I will pick up wines at the tasting room
Ship to this physical address, adult signature required, we suggest a business address for your convenience
Name:_____________________________ M. I.:___ Last Name:_________________________
Company:_________________________________________________________________________
Attention: _______________________________________________________________________
Street:_________________________________________________ Suite or Apt.#:_______________
City:_________________________________________ State:_______ Zip:____________________
Home Phone:____________________ Work Phone: _________________________
E-Mail:_______________________________________________________
Mailing Address (if different from shipping):
Street:_________________________________________________ Suite or Apt.#:_______________
City:_________________________________________ State:_______ Zip:____________________
Payment Method:
VISA
MasterCard
American Express
Card #:___________________________________________________________________________
Expiration Date:_____\_____
Name on the Card: __________________________________________________________________
Signature:__________________________________________________________________________
Must be 21 years of age
I agree to accept shipments of Black Sheep Wine Club Selections and have
them charged to the above credit card.
Black Sheep Winery
P. O. Box 1851
Murphys, CA 95247
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(209) 728-2157
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Copyright © 1996 - 2008 Black Sheep Winery
All rights reserved