User Account Deactivation Request
Please complete this form to request deactivation of your user account. All information will be used to verify your identity and process your request securely.
Full Name
*
First Name
Last Name
Email Address Associated with the Account
*
example@example.com
Username or Account ID
*
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please select the main reason for deactivating your account
*
No longer need the account
Privacy concerns
Too many emails/notifications
Found a better alternative
Temporary break
Other
Please provide any additional feedback or comments
Have you experienced any issues with our service?
Yes
No
Would you like us to contact you to discuss your experience before deactivation?
*
Yes, please contact me
No, proceed with deactivation
Last Login Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Do you want to receive a copy of your data before deactivation?
*
Yes, email me a copy
No, I do not need a copy
How satisfied were you with our service overall?
1
2
3
4
5
I confirm that I want to deactivate my account and understand this action is irreversible.
*
I confirm and request deactivation
Submit Deactivation Request
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