Emerald Wash Club Membership

Cancellation Request

First Name*
Last Name*
Phone Number*
Email Address*
Number of vehicles requesting to CANCEL*
Please enter a number from 1 to 10.
Vehicle 1 Information:
Year*
Make*
Model*
License Plate #*
Vehicle 2 Information:
Year
Make
Model
License Plate #
Vehicle 3 Information:
Year
Make
Model
License Plate #
Reason for Cancellation*
Terms*
- Please carefully review your personal and vehicle information to confirm accuracy of information entered. By clicking here, you are confirming cancellation of your Emerald Wash Club Membership for the vehicles you've listed above. Please keep in mind that it may take up to 48 hours for cancellation to be processed and cancellation requests are processed only during Corporate Office business hours (Monday - Friday: 8:00AM - 4:30PM). You will receive confirmation via email once cancellation has been processed.
eSignature*
By signing here, you agree to the Terms stated above. Type your full name into the blank as your esignature.

It’s been a pleasure doing business with you! If you have any questions about your Emerald Wash Club Membership, please don’t hesitate to contact us.

Vehicle 1 Information: