Just Add Wine�
�For the Finest in Dinners, Events and Travel � Just Add Wine�!�
EVENT REGISTRATION AND PAYMENT FORM
Please sign me up for the following event: ________________________________________
Event Date: _______________________ Location: ____________________________
Name as it appears on the card: _______________________________________________
(if different than customer name)
Billing Address: __________________________________________________________
Address
_____________________ __________________________________________________
Day Phone Number City, State, Zip
___________________________________________________________________________________________________
E-Mail Address
Visa _____ MasterCard_____ Is this a Debit Card? ________
American Express not accepted at this time.
Credit Card Number: __________-___________-__________-____________
(PLEASE PRINT CLEARLY! Obtain imprint of the card if cardholder is present)
Expiration Date: __________________ CVV Value: _ ______________________
(3 digit number on far right side of signature block on back of card)
Amount to be charged to the credit card: $____________________________________
_____ Initial here if you would like your card to remain on file for speedy reservations.
Cancellation and Refund Policy: Just Add Wine LLC will refund your payment in full if notice to cancel is received (via email, fax or phone) by 5 p.m. within one week prior to the dinner event. If received by 72 hours of the event, a credit will be issued which is valid for 6 months. (For travel charges, please refer to the travel reservation form for cancellation deadlines.)
I understand the above reference payment for services and the policy on refunds for cancellation of services. I agree to pay the above total amount according to the card issuer agreement.
________________________________________ __________________________
Signature Date
________________________________________
Printed Name as it appears on card
