Recipient:
Address:
City and Zip Code:
Recipients's phone:
Length of membership: Desired start date:
Message on gift card:
Please circle one:	Visa         Master Card         American Express       Discover
Credit card number:
Expiration and 3 digit code from back:	Expiration:                      3 Digit Security Code:
My name as it appears on my credit card:
My phone:
My billing address:
I acknowledge that I am 21 years of age or older and if this subscription to the wine-of-the-month club is given as a gift that the recipient is 21 years of age or older. I understand that whether the wine will be picked up at the store or delivered, proof of legal age may be required. My Date of Birth MM/DD/YYYY:    ____/____/________ Signed:  __________________________________    Date:  _______________
JOY Wine & Spirits appreciates your business. Our wine-of-the-month club consists of one white and one red wine chosen for their value and quality. Each month costs $20 plus 8.1% sales tax, starting at a four month minimum. Please fax this completed form to 303-765-4580. We will follow up with a comfirmation phone call to you. Joy Wine & Spirits - 1302 East Sixth Ave - Denver, CO 80218 - 303-744-6219
Fax lines are a secure way to communicate your credit card number. We are very careful of your credit card number once it arrives at the store. Please make sure you do not leave this document in the fax machine when you are done. If you are concerned about the security of your faxing environment, feel free to leave your credit card information off of the form, fax the form to 303-765-4580 and give us a call at 303-744-6219 with your credit card number. Thank you.