Winery Member Application

Winery Name*
Main Business Representative*
Office Email*
Office Phone*
Winery Street Address
Street Address City State ZIP Code
Mailing Address
Street Address City State ZIP Code
Additional Information
This information is welcomed but not required
Year Established
Owner/CEO & Email
Winemaker & Email
Accounting Manager & Email
Marketing Director & Email
Tasting Room Manager & Email
WINES VINIFIED
This information is welcomed but not required
Wine by Varietal & Cases Produced
Wine by Varietal & Cases Produced
Wine by Varietal & Cases Produced
Wine by Varietal & Cases Produced
Wine by Varietal & Cases Produced
Wine by Varietal & Cases Produced
2018 Winery Member Dues
Membership dues are $2.50 x (Alexander Valley Tons Grown + Tons Crushed). There is a minimum $300 and maximum $5000.
Alexander Valley Tons Grown*
Tons Crushed*
Calculated Amount Due*
Price: $0.00
Minimum or Maximum Payment Overrides
There is a minimum payment of $300 and maximum payment of $5000. Please check one of these boxes if your calculated amount due is under the minimum or over the maximum.
- My calculated payment is under the minimum $300
- My calculated payment is over the maximum $5000
Actual Amount Due: Minimum Payment
Price:
Actual Amount Due: Maximum Payment
Price:
Payment Method*
If paying by check, make payable to Alexander Valley Winegrowers. Please send checks to PO Box 248, Healdsburg CA 95448.
- I will pay by check
- I will pay now by card
Pay with Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

Additional Information

WINES VINIFIED

2018 Winery Member Dues