Cinquain Club Membership Registration Form

Join the Cinquain Society Wine Club!

Please fill out the following information, and we'll contact you to confirm your information and enrollment. We're available at 805-400-5978 or wineclub@cinquaincellars.com if you have any questions.
Name *

First Name Last Name
E-mail *
Phone Number: *
Birth Date: *

Month Day Year
Billing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Someone 21+ years of age must be available to sign for delivery. Business addresses or FedEx locations are recommended for smooth delivery. Let us know in the notes section if you'd like us to find the nearest FedEx shop to you!
Shipping Option *

2 Bottles Every 3 Months — March, June, Sept, & Dec 4 Bottles Every 6 Months — Apr & Oct (Recommended for warm weather areas)
Pick Up?

I would like to pick up my shipments at the winery.
Shipping Address (If different from billing)

Street Address

Street Address Line 2

City State

Zip Code
Referred By
Notes
We will contact you shortly to complete your membership enrollment.

Thank you for your interest in the Cinquain Cellars Wine Club!
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Join the Cinquain Society Wine Club!