Welltel Service Cancellation Form

DigitalWell Services Cancellation Request
To Cancel any services supplied and to avoid error, DigitalWell require an official request from an authorised customer representative detailing the exact services to be cancelled. It should be noted that the completion and submission of this form does not in itself confirm your services cancellation request has been accepted. Please be mindful of our standard terms and conditions of sale and applicable minimum service term and/or additional contract obligations. Requesting and progressing a service cancellation may result in early termination fees being applied to your account. If you need to check the status of a service supplied please contact your account manager or email sales@digitalwell.com. Our standard terms and conditions of sale, including minimum service term is available here. https://www.digitalwell.com/terms-and-conditions/
Account Information

Please provide the account information requested below
I am a Direct End customer of DigitalWell and want to cancel servicesI am a Reseller for DigitalWell and want to cancel services for one of My customers
Reseller Name*
Reseller Account Number*
As taken from your Welltel invoice.
End Customer Company Name*
End Customer Address*

Address Line 1

Address Line 2

CityState / Province

Postal / Zip CodeCountry
End Customer Company Number*
As taken from your DigitalWell Invoice.
DigitalWell Contact / Account Manager*
If you know the name of your account manager or recent Welltel contact please enter it here or reference 'Unknown'.
Contact Information

Please provide your contact information
Contact Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number

DigitalWell Services Cancellation Request

Account Information

Contact Information

Service Cancellation Request

Service(s) Information

Confirmation

Thank you for your business