EmailMeForm
Order Cancellation Form
Account Rep Email
Account Rep Name
First
Last
Date submitted
MM
/
DD
/
YYYY
Business Name
Did we stop the order due to non-payment?
Please select
Yes
No
How did the client cancel?
Please select
Mail
Email
Phone call
In Person
Did the Account Rep speak to the Account Contact? (The person who placed the order)
Please select
Yes
No
Name of Person who placed the order
First
Last
Was the Person who made the cancellation the same one who placed the order?
Please select
Yes
No
Name of Person who placed the cancellation
First
Last
What was the reason for cancelling
DETAILED NOTES
Was this order cancelled in the middle of a season, sponsorship, or before the fulfillment of the agreement?
DETAILED NOTES
When did this order start?
MM
/
DD
/
YYYY
if unknown, approximate here
When should this order have ended?
MM
/
DD
/
YYYY
OR USE BELOW
When should this order have ended?
Please select
Was on TFN
At the end of this month
Final Billing Month and Year
Amount currently due on Accounts Receivables
Day to stop ads
MM
/
DD
/
YYYY
Amount to bill for final invoice (not total due. What they'll be charged for their final month)
If applicable - What percentage will they be billed for their final month? (100%, 50%?)
Submitted by
First
Last
