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: _________________________
You must mail this completed form to:
Blackjack Ranch Vineyards and Winery