Name of Authorized Person/Cancellation Department
Name of Company/Service Provider
Mailing Address/PO Box no.
City, State, Zip Code
Re: Cancellation of Membership/Subscription No: #_(specify number)_
I am sending this written notice to request the cancellation of my Subscription/membership with
effective date _(mm/dd/yy)_. I would appreciate if you send me a written confirmation of the
same within 30 days. I am enclosing a bank draft worth US$ _(specify amount)_ towards full
and final payment of my outstanding membership/subscription fees. Please ensure that no
further payments are applied to my account henceforth.
Thank you for your prompt attention to this matter.
Sender's Mailing address
Sender's Contact number