Qty	Item	Description	Price	Total
	Subtotal	$0.00

Wayfare

SIX bottles per shipment // FOUR times per year

10% bottle savings // $10 ground shipping // 10% off Villa lodging

Complimentary tastings for FOUR // $100 off gourmet picnic for FOUR

Memer exclusive event invitations

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SIX bottles per shipment // FOUR times per year

$10 ground shipping // 10% off Villa lodging

Complimentary tastings for FOUR // $100 off gourmet picnic for FOUR

Club Only event invitations

Billing Information

Enter your billing information as shown on your credit card statement.

*Birth Date

*First Name

*Last Name

Company

*Address

*City

*State

*Zip Code

*Phone

*Email

Club Notes

Shipping Information

*Birth Date

*First Name

*Last Name

Company

*Address

*City

*State

*Zip Code

*Phone

*Email

Gift Message:

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*Username

*Password

*Confirm Password

Payment Method

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*Credit Card:

*Name On Card:

*Credit Card Number:

*Expiration Date:

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