Yes, I would like to join Gremark wine club!
Please print this form, complete and fax to 805-237-0154 or send to
Gremark Vineyards, 5325 Rancho La Loma Linda Dr, Paso Robles,
CA  93446
Last Name
  
First Name
  
Mailing Address
  
City
  
State
  
Zip
  
Home Phone
  
Email Address
  
Work Phone
  
Daytime Shipping Info:
  
Business Company Name
  
C/O
  
Shipping Address
  
City
  
State
  
Zip
  
Visa  or Mastercard 
  
Card Number                     
  
C V V Number (3 digits on back of
card)
  
Name on Card
  
Expiration Date
  
I understand the conditions of the wine club, that my credit card will be charged for each shipment and the
cancellation requires a 30-day written notice.
**I certify that I am 21 years or older and that the shipments will be received by someone 21 years or older.

___________________________________        __________
Signature                                                        Date