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Online Wine Club Form: $300

If you have a Wine Club, then you'll want take advantage of the immediacy of the web by allowing site visitors to sign up for your wine club online. The form I've come up with collects member information (you'll need a security certificate if you want to collect credit card information) and email's their information to you.

The $300 fee includes installation of the form and customizing it with your information and website design.

Example Wine Club Form

Please feel free to enter fake information in this form because I want you to see how the form works -- but don't include your actual billing info! However, if you want to see what the confirmation email looks like, please include your real email address.

The information at the top of this form can be customized to include club benefits or whatever else you want.

All fields marked with * are required

Account Information: Payment Information:
Name: * Card Type: *
Email: * Card #: *
Options: * Expiration: *
Billing Information: Shipping Information:
Name: * Check if same as Mailing Address.
Company: Name: *
Address: * Address: *
City: * City: *
State: * State: *
Zip: * Zip: *
Phone: * Phone: *
DOB: * Email:
  Terms & Conditions:
I am at least 21 years of age and authorize my credit card to be billed by 'Example Winery' prior to receiving my wine.  I agree to purchase a minimum of two shipments to fulfill the terms of the club membership.

I agree I disagree *