Omega Wine Club Sign Up Form


First Name: *
Last Name: *
   

Credit Card # : *

   
Billing Address : *
City: *
State: *
Zip Code : *

 

 

Shipping Address:

(if different than above)

City: *
State: *
Zip Code : *
Name of Recipient:
Authorization: * By joining the Omega Cellars Wine Club, I authorize Omega Cellars to bill my credit card for each shipment, including shipping costs and taxes. I understand that it is my responsibility to notify Omega Cellars of an intent to cancel the Wine Club membership or change billing and shipping information. I understand that I can cancel my membership at any time, but cannot cancel any shipments within seven (7) days of the shipping date. All shipments will be sent out the fifteenth (15th) day of each quarter. Members will be notified two weeks prior to the shipping date. By submitting this application form, you acknowledge that you and the person receiving each shipment are at least 21 years of age. An adult at least 21 years of age is required to sign at the time of delivery.
 

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