Wine Club Sign Up Form Wine Club Signup "*" indicates required fields Name* First Last Email* Phone*Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Membership Level* Classy Club- $45/mo Elite Club- $65/mo Tax Price: $0.00 Total (including tax) Wine Options* All Red All White Red & White Consent* I agree to automatic billing for a monthly wine subscription until I notify The Classy Cork of my desire to cancel. By checking this box I confirm that I am over 21 and understand that The Classy Cork Wine Room reserves the right to check ID at wine pickup. Credit Card* Cardholder Name Card Details NameThis field is for validation purposes and should be left unchanged. Δ
