Convert Subscription to One Time Purchase

1

About how many shipments have you received?* This field is required.

I haven't received my first order yet.

Only 1

2

NameName used to purchase.

First Name

Last Name

3

EmailThe email used to purchase.

example@example.com

4

Order Number

5

You ordered a subscription with a two shipment minimum commitment. Our product is clearly marked in several places. "This is a subscription product you will not be able to cancel until your second delivery"

Cancel later

Cancel now by changing to a one time purchase. (You will be billed $19.40 next business day)

6

SignatureYou agree to change your subscription to a one time purchase by paying $19.40. Your account will be billed within one business day and your subscription will be cancelled after your payment is processed. This form must be filled out at least 3 business days before your next charge.

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