Membership Application

First name*

Last name*

Street Address*

City*

State*

Zip Code*

Phone*

Email*

Occupation*

Referred by Current Member*

Membership*

Preferred Red Varietals*

Cabernet Sauvignon

Merlot

Pinot Noir

Syrah / Shiraz

Zinfandel

Malbec

Other

Preferred White Varietals*

Chardonnay

Sauvignon Blanc

Syrah / Shiraz

Pinot Grigio / Pinot Gris

Riesling

Moscato

Other

Why Do You Wish To Join the Velvet Fox?

Passions Beyond the Glass

Payment Information

You will only be billed once your application has been approved.

Cardholder's Name*

Credit Card Number*

Expiration Month*

Expiration Year*

CCV/Security Code*

Billing Address - If Different Than Above

City

State

Zip Code

bottom of page