3400 Club Sign Up

Please fill out the form below to start the process of joining the 3400 Club. We will contact you to review your preferences and complete your membership application by phone.

Billing Information
Name*
First Last
Email*
Primary Phone*
Secondary Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is Shipping Information Different from Billing*
- Yes
- No
Shipping Information
Name
First Last
Shipping Address
We Cannot Ship to a PO Box

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Membership Level*
- Silver
- Gold
Delivery Preference*
- Pick Up
- Shipping
Let us know at least 2 weeks in advance of your shipment if the delivery method needs to change.
Wines must be purchased by, shipped to, and signed for by adults 21 years of age or older. Burntshirt Vineyards is not responsible for additional charges for misdirected or returned selections.
Date of Birth*
MM slash DD slash YYYY
Business Name if Applicable
Business Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Message
Phone
This field is for validation purposes and should be left unchanged.

3400 Club Sign Up

Billing Information

Shipping Information

Hendersonville

Chimney Rock