Cancellation Request

Understand why customers leave and offer a chance to retain them

6 fieldsconversationalHas conditional logicCustomer Success

Fields included

Full name*

Short text

Email address*

Primary reason for cancelling*

Dropdown

How satisfied were you overall with the product? (1 = very dissatisfied, 10 = very satisfied)*

Scale

Would you be open to a brief call to discuss your experience?*

Yes/No

↳shows “Best phone number to reach you” if equals“true”

Best phone number to reach you

Phone

Understand why customers leave and offer a chance to retain them

Full name*

Type here...

Email address*

name@example.com

Primary reason for cancelling*

Select...

How satisfied were you overall with the product? (1 = very dissatisfied, 10 = very satisfied)*

Would you be open to a brief call to discuss your experience?*

Yes

Best phone number to reach you

(555) 000-0000

Submit

Identify and qualify participants for user interviews or usability studies

Kick off new customer relationships with the right information

Collect structured support requests for faster resolution