Wine of the Month Club Form

Click on above link for Word Format

Each month we will select two wines from Iowa wineries to ship to you.  This is a great way to try all the different Iowa Wines.  You make the choice of the wines you like, by choosing from Reds, Whites, or Blush, or a combination.

We have 2, 3, 6, or 12 month subscriptions available.  Which makes gift buying simple! 

All wine deliveries must be signed for by a person over the age of 21, please make sure someone will be available to sign when it arrives.  We recommend that wines be delivered to a work address. 

Due to the differing state laws, currently we will only be able to ship in Iowa.

Ship to: (all recipients must be over 21)

Name: ________________________________________________________________________________________

Address: ______________________________________________________________________________________

2 Whites _____   2 Red _____   2 Blush _____   Combination _____

_____ Dry   _____ Semi Sweet   _____ Sweet

2 month $98 _____   3 Month $145 _____   6 Month $280 _____  12 Month $530 _____

Bill to:  Same _____      Phone: __________________________________

Name: _________________________________________________________________________________________

Address:  ______________________________________________________________________________________

MC/Visa/Discover: _______________________________________________________

Expiration: ____________________   CCV: _______________________