Sanders Ridge Carlos Club Membership Application 

 
Two shipments of six bottles of our Muscadine wine will be sent out in February and August - at a cost of $82.50 per shipment.
Total annual cost is $165 ($115 plus $50 shipping*)

We are working on an on-line form.  Until then, please print this form, fill it out and mail it in to Sanders Ridge Wine Club, 3200 Round Hill Road, Boonville, NC 27011 - or give Cindy or Sara a call at 336 677-1700 (Monday - Friday, from 9am to 6pm) and we'll take the information over the phone.

Name:  _____________________________________________________________

Street Address: ______________________________________________________

City: _________________________________ State: _______________________

Zip Code: __________________

Day time Phone: _________________________________________

Alternate Phone: ________________________________________

Email: _________________________________________________________________

Birthday: __________________________________________

Card Type:  Circle One    Visa     MasterCard    Discover

Card Number: _______________________________________________________________

Expiration Date:  Month ___________  Year _____________

Billing Address: __________________________________________________

                          _______________________________________ Zip Code: _______________

Pick Up at Winery?  Yes______  No________

Shipping Info (If different from above):

Name: ____________________________________________________________

Street Address: ___________________________________________________

City: ______________________________ State: ___________  Zip Code: ________________