Silver Spur Wine Club

Please print and complete this form then fax it to us at (512) 858-2020 or mail it to:       Driftwood Vineyards, 4001 Elder Hill Road, Driftwood, TX 78619

By signing this form, I accept the terms of the Silver Spur Wine Club membership:
I am at least 21 years of age.
I agree to receive at least 2 shipments, charged to my credit card.
I will give Driftwood Vineyards 60 days advanced notice in writing if I desire to              terminate my membership after the first two shipments.

Name, please print: ____________________________________________________

Signature and date: ____________________________________________________

By signing above I certify that I am 21 years of age or older. And, I hereby authorize     Driftwood Vineyards to charge my credit card for each Wine Club shipment.

Check One:   Winemakers all Red Selection.    Winemakers Variety Selection

Shipping Address: (We prefer a business as an adult signature is required)

Name:  _____________________________________________________________

Company Name ______________________________________________________

Address: ____________________________________________________________

City, State, Zip ________________________________________________________

Day Phone: __________________________________________________________

E-mail:  _____________________________________________________________

Billing Address: (If different from shipping address)

Name:  ______________________________________________________________

Address: _____________________________________________________________

City, State, Zip _________________________________________________________

Card Type: (Circle one) Visa   M/C   Amex   Discover

Card Number:  ________________________________Expires (mm/yy)______________