Name on Agreement:
Agreement Number, if any:
Date of Expiration:
Dear Sir or Madam:
Please cancel my ________________ (Membership or Subscription) effective immediately. Please be sure to cancel any debits or other automatic charges to any of my accounts. Please check this carefully and send me confirmation of your actions so we both know it has been completed.
Please refund the full amount of my remaining balance.
Please contact me immediately if you have any questions or need more information.
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