□ I certify that I am 21 years of age or older
Please select one of the following Packages:
□ Estate Reds □ Great Reds □ White & Red
Ship to Information: (if possible it is best to ship wine to a business location where someone will be
available to sign for the package during normal business hours.)
Full Name: ____________________________________________________________________________
Business Name (if shipping to business location): ____________________________________________
Address: ______________________________________________________________________________
City, State, Zip: ________________________________________________________________________
Day Phone: ______________ Evening Phone:______________ E-Mail:___________________________
Check this box for TASTING ROOM LOCATION PICKUP □
Bill to Information:
Full Name on Credit Card: ________________________________________________________________
Billing Address for Credit Card:____________________________________________________________
City, State, Zip: ________________________________________________________________________
Day Phone: ______________ Evening Phone:______________ E-Mail:___________________________
Credit Card Type: Visa □ Mastercard □ Amex □ Discover □
Credit Card Number: _______________________________ Expiration Date: ______________________
Signature:________________________________________ Date of Application: ___________________
Please mail or fax the completed application to: Joyce Vineyards
60 Via Milpitas
Carmel Valley, CA 93924
Fax: 831-659-0312