High Rollers Club Membership Cancellation Request Form


Please print and mail this form to the address below.

Your Wine Club Membership is not canceled until you have received our written confirmation. Please allow 21 days for our written confirmation.

Please complete and sign the form below.

Wine Club Member Number: ________________________________________

Member Name: ____________________________________________ Date: ___/____/____

Company Name: _____________________________________________________________

Shipping Address: ____________________________________________________________

City: ________________________________________ State:_____ Zip Code:____________

Telephone: ________________________________ E-Mail: ___________________________

Business Phone : ________________________________FAX: _________________________

Signature ___________________________________________

You must mail this completed form to:

Blackjack Ranch Vineyards and Winery
2205 Alamo Pintado Road
Solvang, California 93463


Upon receipt of this form completed in full, we will confirm that we have received your cancellation notice and that we have removed you from our active membership roster. Please allow a reasonable period of time for us to confirm the cancellation.