Gladstone Vineyard Cellar Club Membership Application
Name (s): __________________________________________________________
Birth date (s): _______________________________________________________________
For each member – day and month only
Physical Delivery Address:
Postal Delivery Address:
if different from postal address
Email: ______________________________________________________________________
Phone(s): Home _________________________ Cell __________________________
Credit Card Number: ________________________________________
Exp ________
Terms and conditions of the Gladstone Vineyard Cellar Club

I authorise Gladstone Vineyard to register me as a member of their Cellar Club and agree
to buying at least two cases of wine per year.

I authorise Gladstone Vineyard to charge my credit card prior to shipping each case.

I agree to this arrangement continuing until such time as I cancel my membership after the
minimum 12 months membership.

I agree that Gladstone Vineyard reserves the right to annually review and change the
terms of this membership (such as increasing the price to reflect inflation) but will only
continue my cellar club member on new terms with my agreement.

I am over 18 years of age.
Signed: ________________________________________
Date: __________
Gladstone Vineyard Cellar Club – tell us what you want!
□ Option 1: Please send me a seasonal case of Gladstone Vineyard and 12,000 Miles
wines twice a year (spring and autumn), and charge my credit card $280 per delivery.
Before each delivery we’ll contact you to let you know what we’re sending in and give you the chance to
make any changes. If you’re happy with the selection we’ve chosen, do nothing and we’ll send you your
wine. If, in the future we need to increase the price of the seasonal case we’ll let you know.
□ Option 2: Please send me a case of my preferred wines when I choose at around 20%
discount on standard retail rates
Before each delivery we’ll pull together a combination of your preferred wines and contact you to
confirm your order and the amount that will be debited from your credit card. You can let us know if you
want to make any changes. If you’re happy with the selection we’ve chosen, do nothing and we’ll send
you your wine.
I would like a mix of:
(tick as many or as few boxes as you like)
□
12,000 Miles wines only
□
Sauvignon Blanc
□
Gladstone Vineyard wines only
□
Pinot Gris
□
Both labels (GV and 12K)
□
Viognier
□
Red only
□
Riesling
□
White only
□
Rose
□
Reds and whites
□
Pinot Noir
□
Cabernet Franc Merlot blend
□
twice a year (autumn and spring)
I would like a case delivered to me:
□
monthly
□
quarterly
You will receive your first case after registering. After that we'll send you your wines as specified
above.
Send your registration form by fax to (+64) 6 379 8564 or mail to Gladstone Vineyard
Cellar Club, RD 2 Carterton 5792, New Zealand