Join the Cellar Rat Wine Club

(see newsletter for other details)

To join, simply print and fill out this form, then fax or mail to

Cottonwood Cellars

P O Box 940, Olathe CO 81425

Fax 970-323-6182

First Name _________________________ Last Name ________________________

Company Name _________________________________________________________

Shipping Address________________________________________________________

City ______________________________________ State _ _ _ Zip _________

Daytime Phone ______ - _______ - ___________ Home Phone ____ - ____ - ____

Billing Address _________________________________________________________

Billing City _________________________Billing State _ _ _ Billing Zip ___________

Credit Card Type (VISA, MASTER) _________________________________

Card Number _________________________________ Exp Date ___ / ____ (MM/YY)

E-mail Address _____________________________________

Signature __________________________________________________

Comments _________________________________________________________

__ Please, contact me as soon as possible regarding this matter.

By enrolling, I will receive 4 shipments per year from $35 to $50 per shipment including shipping, handling and club discount. I understand that I may cancel my membership at any time by calling 970-323-6224. My signature certifies that I am 21 year of age or older.

Due to state specific restrictions, we are limited as to where we can ship. Please see the Shipping Info page or call the winery for more information.

ALCOHOLIC BEVERAGES MAY BE SOLD AND DELIVERED ONLY TO PERSONS WHO ARE AT LEAST 21 YEARS OLD. IN PLACING YOUR ORDER, YOU REPRESENT TO US THAT YOU ARE AT LEAST 21 YEARS OLD. WHEN YOUR ALCOHOLIC BEVERAGES ARE DELIVERED, THE PERSON RECEIVING DELIVERY WILL BE REQUIRED TO SHOW IDENTIFICATION PROVING THAT HE/SHE IS AT LEAST 21 YEARS OLD. COLORADO RESIDENTS MUST SIGN-UP FOR THIS CLUB AT A COLORADO WINE LICENSED EVENT OR IN OUR WINERY.