Enrollment Form

Sign up Today for your Fine Wines & Liquor at Discount Prices New Enrollment Change Information for Existing Card Replacement card

Name:  Address:  City:     State:     Zip: Home Phone:     Business Phone:     Fax: E-Mail Address:     Date of Birth*:   Would You Like To Join Our Mailing List?   Yes   No    * You must be at least 21 to obtain a Preferred Customer Card

As a valued Lake Liquor Customer you receive extra benefits and services not otherwise available.  We guarantee you will be notified by e-mail or registered U.S. mail about special offers and sales of interest to you.  In fact, we will select and customize many of these offers just for you!  Check box if you do not wish to benefit from this service. The Lake liquor Preferred Customer Card is the property of the Lake Liquor.  Please present your card every time you shop with us to receive your special discounts.  Thank You!