Digital Cancellation Request Form |

Advertiser Name*

Please enter the name of the company

Mactive Account Number*

Please enter the advertiser's account number

Local Edge Account Number*

Please enter the LE number

Submitted By*

First Last

Sales Rep's Email*

Sales Team*

Cancel Date*

Cancellation Reason*

Monthly DMS Spend*

Enter only the DMS amount

What is the last month you would like this billed?*

Will you need to issue a credit if the customer is billed this month?*

Please notify Christine Wright for all EMERGENCY cancellations.

Please explain cancellation reason in your own words.

Does the client have Non Local Edge products to be cancelled?*

Please list other Non Local Edge products here.

Please list other Non-DMS products here.