Wine Club Enrollment Form

You can enroll in the Renegade Rebel Wine Club using the secure form below; if you prefer to enroll by phone, please call us during our business hours and we will be happy to take your information and complete your enrollment.

Your Name (required)

Your Email (required)

Your Phone

BILLING ADDRESS:

Cardholder Name (required)

Address1: (required)

Address2: (required)

City: (required)

State: (required)

Zip: (required)

SHIPPING ADDRESS:

Same as billing address

Cardholder Name (required)

Address1: (required)

Address2: (required)

City: (required)

State: (required)

Zip: (required)

Card Number:

Expiration:

CVV Code:

By submitting this form I affirm that I am over 21 years of age and that I am complying with the direct shipment laws in my area, including any volume limits. I also authorize the winery/merchant to store my payment information and to charge my credit card for the above purchase/subscription, including applicable taxes and shipping costs. I understand that the wines I purchase are sold in CA and that title passes to the buyer in CA, and that Renegade Winery makes no representation to the legal rights of anyone to ship or import wines into any area outside of CA. I understand that I the buyer am solely responsible for shipment of wines, and I authorize Renegade Winery and its agents to act on my behalf to engage a common carrier to deliver my order to me. When my wine is delivered to me, I understand that I will be required to show identification proving that I am at least 21 years old.