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I am requesting the cancellation of my auto pay Monthly Unlimited Membership, Class Pass (4,8,12) or Online Auto Renew Membership. My notice is effective the date this form is delivered to Hello@BarreWest.com. I agree that my Monthly Unlimited Membership, Class Pass or Online Membership has met its minimum payment terms as outlined in the membership agreement. *

Agree

I understand that a cancellation request requires 30 days notice for all Auto Renew Memberships. *

Agree

I understand my final account payment may be charged at a pro-rated amount for the remaining monthly obligation should renewal payment fall within the 30-notice period. *

Example: Cancellation request received: April 1st Scheduled Monthly Payment: April 15th (Pay Pro Rated Rate for 15 days (50% of monthly payment)) Cancellation Effective Date: April 30th

Agree