Ivy's Axe Enrollment Form

Name:

Address: City: State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip code:

Email: Phone:

I will retrieve my wine (6 bottles of Harris Bridge wines $150-$225 range per pack, 2-packs per year in May & November) in the following way:

PICK UP at winery and enjoy free tasting
SHIP to the following states: CA, ID, LA, MO, NE, NV, NM, OR, VA, WY
FREE DELIVERY to my door in Corvallis or Philomath

I confirm that I am over age 21

You will receive an email to secure payment information, thank you!