Auto membership Cancellation

1
Name
First Name
Last Name
2
Phone Number
Area Code
Phone Number
3
Email
example@example.com
4
Location
Fremont
Bayfair Mall
Chico Mall
Emeryville
Westvalley Mall
Stonestown Mall
Modesto Eyebrow Plus
Vintage Faire Mall
Capital Mall
Vancouver mall
Pioneer Place
Rogue Valley Mall
Clackamas Towne center
Berkeley
Westfield San francisco
Westfield Valleyfair Mall
Galleria Roseville
The Shops at Tanforan, San Bruno
5
Your next membership payment date* This field is required.(your recurring billing date falls under same day of every term)
Date
Year
Month
Day
6
Reason of cancellation
moving
inconvenient location
do not utilize it enough
opting different eyebrow shaping method
membership pricing
financial reasons
dissatisfied with customer service
other
7
Customer service experienceplease describe the incident
Huge
Large
Normal
Small
Ok
Ok
8
Location you are moving to
9
Eyebrow shaping method
Waxing
Tweezing
Microblading
Electrolysis
Laser
Depilatory cream
Others
10
We are sorry!

We are unable to proceed the cancellation. You have missed the due date to cancel the upcoming renewal.

Please contact our corporate office at 510-623-1013 for further information!
11
Cancellation confirmed
YESNO
12
Confirmation#
Should be Empty: