David Girard Wine Club

Billing Information                                                     

First Name_________________ Last_________________            

Address: ________________________________________             

City: __________________ State: _____ Zip: __________   

Phone: _________________________________________              

Email: _________________________________________

Credit Card:     VISA    M/C    AMEX    DISCOVER

       Number: ____________________________________               

       Exp. Date: _____________      Card I.D. ____________

 

Shipping Information                                                     

First Name_________________ Last_________________            

Address: ________________________________________             

City: __________________ State: _____ Zip: __________   

Phone: _________________________________________              

 

Signature _______________________________   Date  __________

 

Please mail to:

David Girard Vineyards  5784 Thompson Hill Rd.  Placerville, CA 95667
Phone: 530-295-1833   FAX:   530-295-1822