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 Wine Club Sign Up 

Print and fax this form to: (707) 433-3437
Or print and mail to: DLM Wine, P. O. Box 2057, Healdsburg, CA 95448
Winery information: (707) 433-3711

Yes, I have read all about "How The Clubs Work" below and would like to join the Club!

DLM wine Club Members:

Primo Wine Club Members:

Please select your club (check one):

____ Please add me to the Primo Waiting List.

____ Mix n Match

____ Red Wines Only

____ White Wines Only

Once a member, I would like the following wine(s) in my order:


Or, ____ SURPRISE me!


__ Please ship my wine.

__ I will pick up my wine.


Name________________________________________________

email__________________________________________

Phone_______________________________________________

Fax____________________________________________

Billing Address (Please Print)

Shipping Address (We can not ship to P.O. box)

Address_____________________________________________

Address________________________________________

____________________________________________________

_______________________________________________

City_________________________________________________

City___________________________________________

State_____________________________Zip_______________

State____________________________Zip___________

Billing Phone_________________________________________

Shipping Phone_________________________________

Credit Card:  VISA   MasterCard   AMEX  (Circle One)

Card #_______________________________________________

Expiration Date_________________________________

Signature____________________________________________

Date___________________________________________


HOW THE CLUBS WORK: