Discovery Club Membership Programs (indicate number of cases for each program)

Cases from Red Gold Club Program
Cases from White Gold Club Program
Cases from Mixed Gold Club Program

Billing Details

Name
Street address
City Prov Postal code
Email
Phone

Payment Info

Visa Mastercard

Name on Card
Card Number Expiry (mm/yy)

Is this a gift membership?

Yes
No

Shipping Info:
Pick up at the winery
Ship to the billing address
Ship to the following address:

Name
Street address
City Prov Postal code
Email
Phone

I understand and agree to the terms and conditions of the Fort Berens Discovery Club. I understand that I will continue to receive wine shipments and that my credit card will be charged accordingly until I cancel my membership by notifying Fort Berens Estate Winery at least 30 days prior to the next shipment.