New Customer – Longoria Wines Online Store

New Customer

Please specify your contact information. You will have the opportunity to enter separate billing and shipping information on the next screen.

Existing customers: Date of birth now required. Please enter your date of birth in the appropriate field and click "Save."

First Name:

Last Name:

Phone Number: Why is this needed?

Phone Ext: (optional)

E-Mail Address: Why is this needed?

E-Mail Address: Re-type to confirm

Date of Birth:(mm/dd/yyyy)

Address Line 1: (or Company Name)

Address Line 2: (optional)

City:

State/Province:

Zip/Postal Code:

Country:

Address Type:

Business Residential

This is my Preferred Ship-To Address

This is my Preferred Bill-To Address

If you wish, you may create a password for use in the Longoria Wines Online Store. You may use any combination of letters, numbers, and punctuation, but please do not use spaces. Password is optional!

Password: (optional)

Password: Re-type to confirm

866-759-4637

info@longoriawine.com

Returning Customer?

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