utility

CANCELLATION FORM

Maintenance Cancellation Form

FOR INTERNAL USE ONLY

This form is to be filled out by the employee handling the customer cancellation. Once completed it will automatically be forwarded to the appropriate manager.

Customer Name(Required)

First Last

Customer Phone(Required)

Customer Email(Required)

Your Location(Required)

Length of each maintenance visit over last 2 months(Required)

Service work performed over last 2 months?(Required)

Any missed/rolled?(Required)

Yes

Please Explain

Any complaints or issues over last 2 months?(Required)

Yes

Please Explain

Any Incentives/compensation offered?(Required)

Yes

Please Explain

Summary of conversation

Name/number of techs who have cleaned over last 2 months?

Tech 1 - Name

First Last

Tech 1 - Phone

Tech 2 - Name

First Last

Tech 2 - Phone

Tech 3 - Name

First Last

Tech 3 - Phone

Tech 4 - Name

First Last

Tech 4 - Phone

Tech 5 - Name

First Last

Tech 5 - Phone

Tech 6 - Name

First Last

Tech 6 - Phone

Tech 7 - Name

First Last

Tech 7 - Phone

Tech 8 - Name

First Last

Tech 8 - Phone

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