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Letter to Disable Automatic Billing - Template Form Pro · US-law

✓ Valid in United States · drafted to comply with local law

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Letter to Disable Automatic Billing - Template Form
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NOTICE OF REVOCATION OF AUTHORIZATION FOR AUTOMATIC BILLING AND REQUEST FOR ACCOUNT CANCELLATION

________
________
________
________

Date: ________

________
Attention: ________
________

Sent via: ________

RE: Revocation of Authorization for Recurring/Automatic Payments and Cancellation of Account No. ________

To Whom It May Concern:

§ 1. Purpose. This letter serves as my written notice revoking any and all authorization previously granted to ________ (the “Company”) to initiate recurring, preauthorized, or automatic charges, electronic fund transfers, or other withdrawals against my account, and as my request to cancel my account and any related subscription or service.

§ 2. Account Identification. This request relates to the account, subscription, or service identified by Account Number ________, held in the name of ________, and associated with the payment method ending in ________.

§ 3. Recurring Charge. The Company presently bills my account on a ________ basis in the amount of $________ (________), which sum is automatically withdrawn from my account.

§ 5. Cancellation of Account. In addition to the revocation set forth above, I request that my account and any associated subscription, membership, or service be fully canceled and closed as of ________.

§ 6. Final Withdrawal. I understand and expect that the final automatic withdrawal, if any, shall occur on or before ________, and that no further charges shall be made thereafter.

§ 8. Notice to Financial Institution. I am providing, or have provided, a copy of this notice to my financial institution and have instructed it to stop payment on and decline any future preauthorized transfers initiated by the Company.

§ 9. Written Confirmation. Please confirm in writing, within ________ days of receipt of this letter, that (a) this request has been received; (b) the automatic billing has been canceled; and (c) my account has been closed and shows a zero balance. Please direct all correspondence to me at the address, email, or telephone number set forth above.

§ 10. Questions. Should you have any questions or require additional information to process this request, please contact me immediately at the contact information provided above. This letter is not, and shall not be construed as, a waiver of any of my rights.

Sincerely,


________
Signature: ________
Date: ________

Enclosures: ________

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