Boyden VIP Date* Date Format: MM slash DD slash YYYY Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* Untitled* I understand that I am committing to purchasing 4 cases (12 bottles each) of wine within 1 year from the date on this form. I authorize Boyden Valley Winery to automatically charge my card on file every three months for my pre-selected cases of wine. I understand that if I would like to make any changes to my pre-selections, I must call at least 1 week prior to the 1st of the month in which my case is scheduled to ship. I understand that the $25 Membership Fee will be charged to my first order. If I cancel my membership BEFORE my 4th Case is purchased I am responsible for paying: The difference between the membership price (20% Off) and the normal case price (10% Off) on all wine already purchased; Any Free Tastings already used for that year; a $50 Administration Fee; AND your $25 deposit is non-refundable. If I wish to cancel your membership AFTER your 4th Case is purchased, there is no penalty! I also understand that my membership does not include discounts on ciders, spirits, or 50ml mini bottles.