Withdrawal form
To “Act On Crisis”, refering to the Company UAB Emocinis balansas (reg.nr. 305553328), address: Kelme, A. Mackevičiaus str.. 23-25, Lithuania, e-mail address: info@actoncrisis.com, phone No.: +37061829342.

Informing about the refusal of agreed services:
Date of the agreement *
MM
/
DD
/
YYYY
Full Name *
Email address *
Phone number *
Please provide your bank account number and IBAN that you wish to receive a withdrawal. The account number must be linked to your full name provided in this form. *
What is the reason for your withdrawal? *
What is your experience so far with AOC? *
In your opinion, what is valuable that AOC provides? *
In your opinion, what could be improved and how? *
How likely is it that you would recommend AOC to your friend or a colleague? *
Not at all likely
Extremely likely
Do you agree on participating in our user research (surveys, interviews)? If yes, you would be contacted personally and would be enrolled in our benefits pool. *
We will carefully review your submission and contact you for further details
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