First Name:  * Last Name:  * Email Address: Address: City: State: Zip Code:  * Day Phone: Evening Phone: Cell Phone: Fax Number: Pager Number: I prefer to be contacted by: e-MailDay PhoneEvening PhoneCell PhoneFaxPagerMailNo Preference My primary reason for canceling my service is: movingdissatisfaction with servicecostusing another maid serviceother Please enter any information you would like your relationship manager to know prior to contacting you: We regret that you must cancel your Green & Clean maid service. A relationship manager will contact you as soon as possible to confirm the receipt of this cancellation e-mail form. Below you will find a link to a short survey designed to help G&C improve our service in the future. If you have a moment we would appreciate your participation in this survey. Thank you for using this e-mail form and for using Green & Clean maid service. Do not enter anything in this field:

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