Cancellation Form

Please select your wash location.*

Name of the person filling out this form?*

First NameLast Name

Account Holders Name*

First NameLast Name

Would you like to receive a confirmation email when your cancellation has been processed?*

YESNO

Email address?*

Your Phone Number?*

Vehicle License plate number?*

Last 4 digits of the credit card on file?*

Vehicle Year*

Vehicle Make*

Vehicle Model*

Vehicle Color*

Which way would you like to cancel your account?*

Reason for your cancellation?*

Which wash package did you receive?

Please give a brief explanation about the wash quality concerns?

Please give a brief explanation for your cancellation?

Additional comments?

By submitting this form, you confirm that the above information is true and accurate. You confirm that you have the authority to give Red's Car Wash permission to cancel your monthly recurring billing. You understand that misrepresentation may be deemed a fraudulent act. Should you choose to cancel this request once submitted, you must do so in person.