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Mount Pleasant Winery
5634 High Street
Augusta, MO 63332
800-467-WINE
mailto@MountPleasant.com

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VINTNER'S CIRCLE APPLICATION FORM

Simply fill out our online membership application below and we will call you for your credit card information.

If you prefer, you can print an application to mail or fax.

MEMBER INFORMATION:

Name*:
Spouse's Name*:

BILLING ADDRESS:
c/o*:

Company*:

Street*:

City/State/Zip*:

SHIPPING ADDRESS:
c/o*:

Company*:

Street*:

City/State/Zip*:

Note: We recommend shipping to a business address as an adult signature is required for all packages that include wine and shippers typically deliver during business hours.

Daytime Phone*:
Evening Phone*:
Fax:
Other:
E-mail*:
T-Shirt Size:

WINE SELECTIONS:
Please choose one of the two wine selections below

Vintner's Harvest ? Off-dry, Semi-dry, and Sweet Wines:
Each quarterly shipment will range between $20 and $30

Vintner's Appellation ? Off-dry, Dry Reds, and White Wines:
Each quarterly shipment will range between $27 and $37

OPTIONAL ADD-ON SHIPMENT
Sweet Holidays ? Award Winning Ports and Dessert Wines:
Each 2-bottle shipment, delivered once per year, will range between $40 and $60
Yes, add the Sweet Holidays shipment.
No thank you.

ABOUT SHIPMENTS:
Quarterly shipments for Vintner's Harvest and Vintner's Appellation will be made the first Monday in August, November, February and May.

The Sweet Holidays option will be sent the first Monday in December.

Note: Wines are perishable and even the best of carriers will not guarantee delivery against temperature extremes. In such times, we may delay shipping in order to protect your product.

INTRODUCTORY OFFER:
If you join Vintner's Circle six weeks after the previously scheduled shipment, you may choose to receive that particular shipment within three weeks of signing up. After receiving your introductory shipment, you will then begin receiving regular quarterly shipments. Cut off dates are: June 28, September 15, December 22 and March 23.

Yes! Please send me the introductory offer so I may begin enjoying Mount Pleasant wines.
No thank you. Just begin my regularly scheduled shipment.

GIFT RECIPIENT INFORMATION:

Will this be a gift?	Yes No
Gift Card Message:

REFERRAL INFORMATION:
How did you hear about the Vintner's Circle?

Please provide the name of the publication or the person who refered you to the Vintner's Circle.

MOUNT PLEASANT WINERY VINTNER'S CIRCLE POLICIES:
The Vintner's Circle membership card is valid only for the primary member and one other household member at least 21 years of age. You must present a valid driver's license or photo ID with your membership card. The membership card is non-transferable and is the property of Mount Pleasant Winery and can be revoked at any time. The membership discount does not apply in addition to any other discounts or sale prices. Replacement fees for lost cards are $5.00.

All charges include a packaging and handling fee. Shipping charges are additional, applicable by state. We would appreciate it if you would notify us immediately when you get a new credit card or change cards. Shipments will not be sent until charges are authorized and are delivered on business days only. It is very important to inform us of any address changes. Non-deliverable shipments will be returned to Mount Pleasant Winery and all associated charges will be the responsibility of and billed to the customer. Members can withdraw from the club at any time after a minimum of one quarterly shipment and within 30 days of your next shipment by notifying us via phone, fax, mail, or e-mail. Mount Pleasant reserves the right to modify pricing, modify or terminate the terms of the club at anytime.

Mount Pleasant Winery promotes responsible wine consumption. Alcoholic beverages may only be sold and delivered to persons who are at least 21 years of age. An adult signature is required for delivery. All alcoholic beverages are sold in Missouri and title passes to the buyer in each state. Memberships are only available in the United States of America. Shipping to states other than Missouri may be restricted by individual state law. All terms, policies and procedures are void where prohibited by law.

By submitting your application, either electronically or via mail, you are confirming that you are at least 21 years of age and agreeing to these conditions of membership. In addition, you are committing to the first quarterly or introductory shipment and authorize Mount Pleasant Winery to bill your credit card for each shipment.

I have read and agree to the conditions of membership

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