WINE CLUB REGISTRATION FORM

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A warm welcome from Club W! We are happy to share the wines that we love with you every month and look forward to surprising you with exclusive events and offers yet to come!

Please fill out the following form and select the membership options of your choice. Upon completion of this form, our Club W Coordinator will contact you to verify the information and answer your questions.

Cheers!
The Club W Team

Email *

This membership is mine *

Yes

Required

Full Name

Date of birth (only for surprise gift, we don’t share Members information with third parties)

YYYY

Phone

Shipping Address

Membership Options *

2 bottles per month (@ Kshs 3,000 per month)

4 bottles per month (@ Kshs 5,000 per month)

6 bottles per month (@ Kshs 8,000 per month)

Required

Palate Preference 1 (please pick 1 only) *

Red only

White only

Both

Required

Palate Preference 2 (please pick 1 only) *

Sweet

Dry

Both

Required

Payment Options *

I will pay 3 months in advance

I will pay 6 months in advance ( and get Kshs 500 off / month)

I will pay 12 months in advance (and get one month free)

Required

M-Pesa payment details

Send me a copy of my responses.

Submit

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