AUTO CANCEL FORM

CANCELLATION FORM

AUTOMATIC BILL PAYMENT
Name (Primary Account Holder)*

First NameLast Name
Family Auto, list other names on account
Email*
example@example.com
Phone Number*

Area CodePhone Number
Today's Date*

MonthDayYear
Calculated24hrmin
Today's Date (epoc)
To calculate an epoch date use excel formula =(A1-DATE(1970,1,1))*86400 where A1 is the first day of the month.
Last Day of Package

MonthDayYear
Calculated-read only
Reason for cancelling*
I understand that this cancellation forms must be received at least 5 days prior to the monthly billing date indicated on your contract. Cancellation forms received after this deadline will be processed during your next billing cycle, and your account will be charged one final time.*

I agree
I understand that the date of cancellation listed on this form is tentative, pending a review of my contract by the studio management. If the terms of my contract have not been met, I may be charged regular monthly charges until the terms of my contract have been met, or I may be asked to pay a fee for early termination of the contract.*

I agree
By clicking Submit, you electronically sign the cancellation form. A copy of the form will be sent to the Front Desk to be processed within 5 business days. You will immediatly receive a copy of this form, in the email provided, as a record of submission. Please maintain a copy for your records. If you did not recieve a copy, please retry again or see the Front Desk Personnel for further assistance.
Signature

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Form Update 5/13/13
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CANCELLATION FORM