Recipient Name *

First Name

Last Name

Recipient Shipping Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Recipient Phone Number *

(###)

###

####

Choose A Membership Collection For Your Recipient *

Four shipments per year, wines and prices are subject to change Select One Option Below

Three Bottle Complete Collection $545 annually, plus tax and shipping

Three Bottle Red Wine Collection $599 annually, plus tax and shipping

Membership Duration

One year memberships end after the 4th shipment. On-going memberships have no end date, no need to renew.

one year

on-going

Choose A Membership Start Date

December 2023

February 2024

Billing Option *

I'd like to prepay for a one - year gift membership, four shipments total.

Please bill me quarterly.

Billing Name *

First Name

Last Name

Are you a current FrogFellow? *

Yes

No

Billing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Billing Phone *

(###)

###

####

Payment Details *

Select One

I am a FrogFellow - bill my credit card on file.

Please contact me for payment details.

Please read and check this box to agree and continue *

By filling out this form, I understand am requesting to enroll the recipient listed above in The Fellowship of the Frog for the membership term I have selected. I understand that submitting this form does not finalize a gift membership and I will be contacted if additional information, such as payment information, is needed. Once my recipient is officially enrolled, I will receive a confirmation via email of my gift. If I have elected to be billed quarterly, my credit card will be billed four times, the total of each charge will be determined by the wines featured that quarter. Wines and prices are subject to change. I am responsible for all address changes and will be charged for all return and redirect fees should my recipient's Fellow Shipment be undeliverable.

I agree.