Just Testing 8884335454

by seloadmin | Jul 11, 2024 | 0 comments

I got ripped off … please refund

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YOUR NAME*
First Last
YOUR MAILING ADDRESS*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
YOUR EMAIL ADDRESS*
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YOUR HOME PHONE
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HOW CAN WE HELP?*
WE ARE SORRY TO HEAR YOU WANT TO CANCEL YOUR MEMBERSHIP. ALTHOUGH WE HATE TO SEE YOU LEAVE, WILL WILL OF COURSE PROCESS YOUR REQUEST IMMEDIATELY

PLEASE SUPPLY THESE ADDITION DATA FIELDS SO WE CAN MORE EASILY LOCATE YOUR ACCOUNT.
PLEASE SUPPLY THESE ADDITION DATA FIELDS SO WE CAN MORE EASILY LOCATE YOUR ACCOUNT AND PROCESS YOUR REFUND REQUEST.
PLEASE SUPPLY THESE ADDITION DATA FIELDS SO WE CAN MORE EASILY LOCATE YOUR ACCOUNT AND PROCESS YOUR REQUESTED ACCOUNT CHANGES.
FIRST 6 DIGITS OF PAYMENT CARD
PLEASE ENTER THE FIRST 6 DIGIT OF THE CARD NUMBER USE FOR YOUR MEMBERSHIP.
LAST 4 DIGITS OF PAYMENT CARD
PLEASE ENTER THE LAST 4 DIGIT OF THE CARD NUMBER USE FOR YOUR MEMBERSHIP.
PLEASE SUPPLY THE DETAILS FOR THE TRANSACTION THAT YOU ARE REQUEST A REFUND FOR.
CHARGE DATE*
MM slash DD slash YYYY
TRANSACTION AMOUNT*
ADDITIONAL REFUND
CHARGE DATE*
MM slash DD slash YYYY
TRANSACTION AMOUNT*
ADDITIONAL REFUND
CHARGE DATE*
MM slash DD slash YYYY
TRANSACTION AMOUNT*
ADDITIONAL REFUND
CHARGE DATE*
MM slash DD slash YYYY
TRANSACTION AMOUNT*
ADDITIONAL REFUND
CHARGE DATE*
MM slash DD slash YYYY
TRANSACTION AMOUNT*
ADD A NOTE ABOUT YOUR REQUEST*

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Just Testing 8884335454

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