2017 Cancellation Account Credit Request form

2017 Cancellation Account Credit Request form
If you have experienced a Canceled Xoticy® Service during the year of 2017 between the months of 1-7 and you have NOT harassed, bullied, attacked, reported false reports & or lied about and on Ms. Monica Wilson & or Xoticy®. Then you are able to Complete this Xoticy® 2017 Cancellation Account Credit Request Form. Provided your correct knowledge below and submit the required documents to complete this Xoticy® request form.

Purchaser Knowledge
Name

First Name Last Name
Email
example@example.com
Date Of Birth

Month Day Year
Date
Mobile Number
Please enter a valid phone number.
What's are your Social Media Platforms & Names?
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
To complete this request, submit the following check list below
Submit a copy of the front & back of your Active Photo State Driver Licenses/Passport

Cancel of
Submit a copy of your Xoticy® Service Receipt of the canceled Xoticy® Service

Cancel of
Submit a copy of a previous email sent to you from Xoticy® concerning the canceled Service & or Account Credit.

Cancel of