We’re sorry to see you go. To help us improve, would you mind sharing a little more about your experience?

First Name *

Last Name *

Company Name *

Phone *

Email *

What were you hoping to get out of Jill’s Office when you signed up? *

If you chose Other in previous question please explain

Did we meet that goal for you? *

What ultimately led you to cancel? (Choose the most relevant reason) *

Was there anything we could’ve done earlier to prevent this? *

Would you be open to someone reaching out to learn more or help?

Yes

Preferred method of contact

Additional details of why you are cancelling *

Do you have any advice on how we can improve our service? *

Are there any of our services you will need in the future? *

Please check to confirm you understand the following details: *

Your card on file will be charged in the next 1-3 business days for the usage you incurred up to your cancellation.

If I want to keep my Jill's Office phone number - I must put in a request to port it within 10 days of submitting this cancellation form.

On a scale of 1-5 overall how happy were you with our service? 1 being the least satisfied and 5 being the most satisfied. *