By completing and submitting the following form, you are agreeing to the terms and conditions of the Cellardoor Wine Society.

All fields with a (*) are optional

First Name Last Name
Address
City State Zip -
Area Code Phone

Credit Card Number

Type Expiration DateName on Card

SIGNATURE ____________________________________________________

I will Pick up my wine each month at: (check one)

Rivendell Winery in New Paltz _____ Vintage New York in SoHo _____

Please Send my Monthly Selection Via UPS to the Address Above _____

The following space is provided for any comments, questions, concerns or if there are special requests or instructions that we may need in order to serve you better.

Please print this form and fax to (845) 255-2290

RIVENDELL WINERY

714 ALBANY POST ROAD

NEW PALTZ, NY 12561

845-255-2494

FAX 845-255-2290

EMAIL finenywine@aol.com

By completing and submitting the following form, you are agreeing to the terms and conditions of the Cellardoor Wine Society.

All fields with a (*) are optional

First Name Last Name
Address
City State Zip -
Area Code Phone

Credit Card Number

Type Expiration DateName on Card

SIGNATURE ____________________________________________________

I will Pick up my wine each month at: (check one)

Rivendell Winery in New Paltz _ Vintage New York in SoHo _

Please Send my Monthly Selection Via UPS to the Address Above _____

The following space is provided for any comments, questions, concerns or if there are special requests or instructions that we may need in order to serve you better.

Please print this form and fax to (845) 255-2290

The following space is provided for any comments, questions, concerns or if there are special requests or instructions that we may need in order to serve you better.

By completing and submitting the following form, you are agreeing to the terms and conditions of the Cellardoor Wine Society.

All fields with a (*) are optional

First Name Last Name Address City State Zip - Area Code Phone

Credit Card Number

Type Visa MasterCard American Express Expiration DateName on Card

SIGNATURE ____________________________________________________

I will Pick up my wine each month at: (check one)

Rivendell Winery in New Paltz _____ Vintage New York in SoHo _____

Please Send my Monthly Selection Via UPS to the Address Above _____

The following space is provided for any comments, questions, concerns or if there are special requests or instructions that we may need in order to serve you better. Please print this form and fax to (845) 255-2290

The following space is provided for any comments, questions, concerns or if there are special requests or instructions that we may need in order to serve you better.

First Name Last Name
Address
City State Zip -
Area Code Phone

Type Expiration DateName on Card

Rivendell Winery in New Paltz _ Vintage New York in SoHo _

The following space is provided for any comments, questions, concerns or if there are special requests or instructions that we may need in order to serve you better.

Please print this form and fax to (845) 255-2290