Order Cancellation Form

Customer Information

Name: Email: Phone Number: Address:

Order Information

Order Number: Order Date: Product(s) Ordered: Reason for Cancellation:

Cancellation Details

Preferred Resolution: Additional Comments:

Refund Information

Preferred Refund Method:

Customer Agreement

I hereby request the cancellation of the order as specified above. I understand that the processing of this cancellation request will be in accordance with the seller’s cancellation and refund policies.

Customer Signature: Date: