Name *

First Name

Last Name

PREMIUM Series ($119/mo)

2 Bottles of Red

1 Bottle of Red / 1 Bottle of White

SELECT Series ($74/mo)

2 Bottles of Red

1 Bottle of Red / 1 Bottle of White

SELECT + PREMIUM WHITE Series ($94/mo)

1 Premium White + 1 Select White

CHOOSE YOUR PREFERRED STARTING MONTH *

January

February

March

April

May

June

July

August

September

October

November

December

MAKE IT A GIFT SUBSCRIPTION (Optional)

Give the gift of wine witha gift subscription for the Wine-lover in your life

1 Month Gift Subscription

2 Month Gift Subscription

3 Month Gift Subscription

6 Month Gift Subscription

12 Month Gift Subscription

Ongoing until I Choose to Cancel

Credit Card Type *

Visa

Mastercard

American Express

Authorization *

I hereby authorize Copperhouse Eatery + Lounge to charge my credit card at the beginning of every month for the subscription amount plus GST. I understand that I may cancel my subscription at any time before the 20th day of the preceding month by sending an email requesting cancellation to wine@copperhouse.ca.

Copperhouse Rewards

Please add my Copperhouse Reward points for this transaction to my profile or if I’m not already signed up, please sign me up and add my points.