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Lingua Franca LLC
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Chardonnay
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GIFT MEMBERSHIP
Wine Club & Gift Form
*First Name
*Last Name
*Email Address
Company
*Billing Address
*City
*State
*Zip Code
*Country
*Is this a gift for someone else?
Yes
No
If a gift, Recipient's First Name
Recipient's Last Name
Recipient's Email
Recipient's Phone Number
Recipient's Birthday
Recipient's Birth Month
Recipient's Birth Year
*Purchaser's Phone Number
*Purchaser's Birth Day
*Purchaser's Birth Month
*Purchaser's Birth Year
Name on Credit Card
Credit Card Number
Expiration Date
Which Club Would You Like to Join?
The Estate Club: 4 Bottle Allocation Three Times a Year
The Vintage Club: 8 Bottle Allocation Three Times a Year
How Would You Like to Receive Your Allocation
Ship to My Address
I'll Pick It Up at the Winery
Do you have any additional Questions or Comments?
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