I hereby request that all further automatic payments to my CULS, number , be cancelled as of .
Reason for cancellation:
ACCOUNT PAID IN FULL
I HAVE DECIDED TO MAKE PAYMENT BY MAIL
Please allow two (2) business days for the cancellation to take effect. Requests must be received by 11:00 am Eastern Time. All requests received after 11:00 am Eastern Time will begin processing the following business day. Previously authorized deductions that process prior to the cancellation taking effect will be refunded only if the account was paid in full prior to the deduction.
I hereby authorize CULS to accept the checking of this box in lieu of my signature. (Online submission)
DATE: PHONE: EMAIL:
Type the correct combination of letters and numbers as shown above:
Note: Please click on the Submit button only one time.
The COMPANY will respond to your transmission within one business day.