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© 2007 Lucero Vineyards        |        P.O. Box 244        |        Dobbins, CA 95935        |        (530) 692-1141

Wine Club Membership Form

Billing Information
City:   State: Zip:
Telephone Number: Home: Fax:

Payment Method
Visa MasterCard American Express
Credit Card Number: (no "-" or space. Ex: 1234567890123456)

Experation Date:


Shipping Adress
City:   State: Zip:
Work Phone Number:

Note: By law, we may only ship wine to: AK, AZ, CA, CO, DC, FL, GA, HI, IA, ID, IL, LA, MN, MO, NC, ND, NE, NH, NM, NV, OH, OR, SC, TX, VA, WA, WI, WV, WY. We cannot deliver to P.O. boxes. The law require an adult signature on all shipments of wine. (We recommend shipping to a business address, if possible.)

By submitting this form, I certify that I am 21 years of age or older and give my permission to Lucero Wineyards & Winery to charge my credit card for each shipment at the time of shipping.