Your Préname/Name
Address
Postal Code/City
[Name of Company or Association or Préname]
Address
Postal Code/City
Done à [your city], on [précate date].
Object : Request for reconciliation regarding [state subject of your reconciliation]
Madam, Sir,
I have subscribed with your [société] a subscription/membership on [indicate date of contract signature], in order to receive [indicate the product or service involved;].
I hereby request that you consider my request for non-renewal. In accordance with your general conditions my subscription/membership will end on [indicate the date your subscription/membership ends].
I thank you for confirming that my request has been taken into account.
Please accept, Madam, Sir, my best regards.
[Your signature]