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Customer Cancellation

🚫 Important Notice - No AI Assistance Permitted

This form must be completed personally and honestly by the responsible team member.

Use of AI tools (including ChatGPT, Gemini, Copilot, or any automated writing or reasoning assistant) to fill in any part of this form is strictly forbidden.

This document is intended to capture genuine human reflection, accountability, and understanding of the situation.

Basic Information

Client name & business name

*

Staff member handling account

*

Your name (only if different from above)

Service

*

Service

A

PPC

B

SEO

C

PPC & SEO

Date of cancellation request

*

Time remaining on contract (in months or days)

*

Monthly payment amount (total monthly loss to the business)

*