Richies Carwash Membership Cancellation Request Form

1

Date* This field is required.

Date

2

Name* This field is required.

First Name

Last Name

3

Customer Sticker Number* This field is required.The number on your window sticker

4

Phone Number* This field is required.

5

Email* This field is required.

example@example.com

6

What would be the single biggest improvement Richie's Car Wash could make to provide a great carwash experience, in your opinion?

8

I hearby certify that I wish to cancel my membership with Richie's Cawash. I understand that my account must be in good standing in order to complete this request. I understand that I am responsible for any billing that will occur within the next 30 days.

9

Signature* This field is required.

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