Membership Cancellation Form

Dear respected member, thanks for being a valued customer. It was a great pleasure serving you. Although it is heartbreaking to let you go, we respect your thoughtful decision. Please feel free to reach out if you think we can work out your concerns or an alternative could be made. Also, shop for a number of other options such as getting an interest-free loan, withdrawing the balance, or freezing membership that might work for you rather than leaving. if you still determined to cancel your membership, we would be happy to accommodate that!
Membership Cancellation Form
Membership ID*
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Driving License No.*
E-mail*
example@example.com
Total Savings Balance (USD)*
Is there any loan balance unpaid/due?*
Unpaid Loan Balance (USD)*
Net savings balance after deducting the loan balance? (USD)*
Is there any other fee/money unpaid/due or you owe to Mercy Financials?*
How much you owe to Mercy Financials? (USD)*
Net savings balance after deducting all dues? (USD)*
PayPal ID*
Please make a payment of $20 at (paypal.me/alamanahtrust) and copy the transaction ID here *
Reason of Cancellation*
Feedback about us:*
Suggestions if any for further improvement:
Signature*

Clear
Today's Date*

MonthDayYear
Should be Empty: