________
________
________

Date: ________

________
________

RE: Cancellation of Automatic Billing

To whom it may concern:

This letter is to cancel my automatic billing with your company. My account number is ________.

Each week, the amount of $________ (________) is billed to my account.

This amount is automatically withdrawn. I would like to immediately cancel these automatic withdrawals so please consider this letter official revocation of authorization. Please also note my request to fully cancel my account with your company.

I expect the last automatic withdrawal to be on ________.

If further information is required, please let me know. Otherwise, please confirm in writing that my request has been received and the automatic billing will be canceled.

Sincerely,

________