Cancellation Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

PLEASE note that we require a minimum of 5 business days to process cancellations. If you send your request with less notice, we may not be able to prevent your upcoming payment and it will not be refunded.

If you wish to cancel your ONE-YEAR CONTRACT before your 4-month minimum commitment is complete, you will be charged a 10% fee for each month on your one-year contract that you did not fulfill. After 4 monthly payments, the studio will continue to charge the student’s credit card for the membership on a monthly basis, unless notified of cancellation at least 5 business days prior to next pre-authorized payment date.

Email *

NAME *

Phone Number *

Cancellation Date *

YYYY

Reason for Cancellation *

I understand that: *

It is my responsibility to ensure that my contract is suspended or cancelled as needed.

It can take up to 5 business days to process suspension and cancellation requests.

If my form is submitted less than 5 business days before my next autorenew charge, Modo Yoga NDG may not be able to intercept the upcoming charge and it will not be refunded

Before 4 monthly payments have been made on this contract, Modo Yoga NDG reserves the right to charge a cancellation fee if the student wishes to break their contract.

If I have not yet made 4 monthly payments, my cancellation fee will be equal to 10% of each remaining month on the 1-year contract, plus taxes.

I can suspend ("pause") my contract for up to 3 months, but I prefer to cancel.

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Sara Gallagher Bloom. Report Abuse

Forms