Form to cancel a user account

It is an important issue to let users manage their information on the web.
This kind of form would be professional and useful don't you think so ?

Cancel My Account

We want you to have a subscription to our site because you love using it, not because you were unable to cancel your account. In fact, we are so confident that our product is one of the best on the market, we're not afraid to make it simple to cancel your account at any moment. After filling out this form, your account will be automatically cancelled.

If you want to cancel your account, simply fill out and submit the form below.
Feedback
Why have you chosen to cancel your account? Is there anything we could have done better?

Is there anything we could do to keep you as a customer?

Confirm Cancellation

Please check each box to confirm that you agree to the statements below.
My profil will be deleted.
All my comments will be deleted.
All my personal contents will be deleted.

Note: Cancellation of your account does not automatically resolve any past due balance and all refund requests will be addressed in accordance with the terms and conditions specified in the End User License Agreement.