Cancellation of Service Request Letter

for Your State

This Cancellation of Service Request Letter will effectively cancel a service, such as newspaper or bottled water delivery. This letter can easily be customized to fit your needs and can be sent via regular or email.

File types included

  • Microsoft Word
  • Adobe PDF
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  • Rich Text Format

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This Cancellation of Service Request Letter will effectively cancel a service which is now provided by a company. This easy to customize letter contains the name of the service provider, the type of service to be cancelled (i.e., ,delivery of bottled water, newspaper or landscaping), the service address and effective service cancellation date. It also includes account name and number information (if applicable). A written Cancellation of Service Request Letter will serve as a record of your cancellation of the service in the event you are assessed future fees for the service or a non-cancellation fee.

This Cancellation of Service Request Letter sets out the following:
  • Parties: The name of the service company and the customer;
  • Cancellation Information: The service being provided, the effective date of cancellation and account holder and account number information.

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This attorney-prepared packet contains:
  1. General Instructions
  2. Cancellation of Service Request Letter
State Law Compliance: This form complies with the laws of all states
Number of Pages3
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#32652
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.

Cancellation of Service Request

This package contains:

1. Instructions & Checklist for Cancellation of Service Request Letter
2. Cancellation of Service Request Letter 

Instructions & Checklist for
Cancellation of Service Request Letter
?   This package contains (1) Instructions & Checklist for Cancellation of Service Request Letter; and (2) Cancellation of Service Request Letter;

?   This form is designed to assist you in drafting a letter canceling a service i.e. cable service, water service etc..  

?   Be sure to sign the letter and to make a copy before sending it out. 

?   Bracketed instructions may be included on this form to assist you in completing it and should be removed before printing. Generally in Microsoft Word, you can click on the bracketed instruction and start typing.

?   These forms are not intended and are not a substitute for legal advice. These forms should only be a starting point for you and should not be used without consulting with an attorney first. An attorney should be consulted before negotiating any document with another party.

?   The purchase and use of these forms, is subject to the Disclaimers and Terms of Use found at

[Your Name]
[Street Address]
[City, State  ZIP Code]
[phone number - optional]
[email address - optional]

May 19, 2009
[Name of Recipient]
[Company Name]
[Street Address]
[City, State  ZIP Code]Dear [Name of Recipient]:Please consider this is a request to cancel and discontinue [TYPE OF SERVICE] service at [ADDRESS] effective [CANCELLATION DATE] . The account number is [ACCOUNT NUMBER] and is under [NAME OF ACCOUNT].Should you have any questions, please do not hesitate to contact me.
[Your Name]

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