Winegrower Member Application

Company Name*

Vineyard Name*

Main Business Representative*

Office Email*

Office Phone*

Vineyard Address

Street Address Address Line 2 City State ZIP Code

Mailing Address

Street Address Address Line 2 City State ZIP Code

Additional Information

This information is welcomed but not required

Owner/CEO & Email

Vineyard Manager & Email

Accounting Manager & Email

This information is welcomed but not required

Varietal Grown and Acres Planted

Membership dues are $2.50 x Winegrape Tons Grown. There is a minimum $300 and maximum $5000.

Total Winegrape Tons Grown*

Exact Winegrape Tons Grown*

Please enter a number from 120 to 2000.

This number calculates your membership dues

Total Amount Due*

Price: $0.00

Minimum Payment

Price: $300.00

For winegrower members with less than 120 winegrape tons grown

Maximum Payment

Price: $5,000.00

For winegrower members with more than 2000 winegrape tons grown

Pay with Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Pay with Check

Make check payable to Alexander Valley Winegrowers. Please send checks to PO Box 248, Healdsburg CA 95448.