Membership Form

DeVine Membership

Membership rules

Monthly fee for membership is $100 this includes two services that equal over $100 and any additional services at 30% off the total.

All members must sign up for a minimum of six months of membership before any penalties are waived. The penalties for early cancellation will be 50% of whatever remaining months of the membership is due at the time of cancellation.

All fees are due by the 15th of every month late fees will apply after the 15th late fees will not exceed 50% of total membership cost.

My Products

DeVine Membership ($100.00 for each month)

Two services equaling over $100 Any additional services are 30% off the total services

Credit Card

Full Name

Street Address

City

State

Zip Code

Phone Number

E-mail Address

Gender

EMERGENCY CONTACT INFORMATION

Contact Name

Contact Phone Number

Relationship