XOBC Collector Waitlist

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*Last Name

*Address

Address 2

*City

*State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

*Zip Code

*Phone

*Email

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*Collector Club Selection Classic Collector
Crimson Collector
Confident Collector
Captain Collector
Crystal Collector (non-alcoholic)
Custom Collector (36 bottles annually)

*Credit Card Number

*Expiration (mm/yy)

Referral Code

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