Embed

<!DOCTYPE html>
<html lang="en">
<head>
  <meta charset="UTF-8" />
  <meta name="viewport" content="width=device-width, initial-scale=1.0"/>
  <title>Cancel Notary Membership</title>
  <link href="https://fonts.googleapis.com/css2?family=Nunito:wght@400;700&display=swap" rel="stylesheet">
  <style>
    * {
      box-sizing: border-box;
    }

    body {
      font-family: 'Nunito', sans-serif;
      background-color: #f5f6f8;
      margin: 0;
      padding: 0;
      overflow-x: hidden;
    }

    .main-wrapper {
      display: flex;
      flex-direction: row;
      background-color: #fff;
      border-radius: 16px;
      box-shadow: 0 8px 24px rgba(0, 0, 0, 0.1);
      overflow: hidden;
      width: 100vw;
      max-width: 100%;
      margin: 30px auto;
    }

    .form-section {
      flex: 1;
      padding: 40px;
      min-width: 320px;
    }

    .image-section {
      flex: 1;
      background-image: url('https://media.post.rvohealth.io/wp-content/uploads/2020/09/8305-Grief_Series_5-_I_Forgot_to_Say_Goodbye-1200x628-Facebook.jpg');
      background-size: cover;
      background-position: center;
      min-height: 400px;
    }

    h1 {
      font-size: 24px;
      color: #2c3e50;
      margin-bottom: 25px;
      text-align: center;
    }

    label {
      display: block;
      margin-top: 15px;
      font-weight: 600;
      color: #34495e;
    }

    input, textarea, select, button {
      width: 100%;
      padding: 10px;
      margin-top: 6px;
      border: 1px solid #ccc;
      border-radius: 6px;
      font-size: 14px;
    }

    input:focus, textarea:focus, select:focus {
      border-color: #3498db;
      outline: none;
    }

    button {
      background-color: #004080;
      color: white;
      font-weight: bold;
      border: none;
      margin-top: 25px;
      padding: 12px;
      border-radius: 6px;
      cursor: pointer;
    }

    button:hover {
      background-color: #0059b3;
    }

    .note {
      font-size: 13px;
      color: #7f8c8d;
      text-align: center;
      margin-top: 20px;
      line-height: 1.6;
    }

    .note a {
      color: #3498db;
      text-decoration: none;
    }

    .note a:hover {
      text-decoration: underline;
    }

    @media (max-width: 768px) {
      .main-wrapper {
        flex-direction: column;
      }

      .image-section {
        min-height: 220px;
      }

      .form-section {
        padding: 25px;
      }
    }
  </style>
</head>
<body>
  <div class="main-wrapper">
    <div class="form-section">
      <h1>Cancel Your Membership</h1>
      <form action="https://formsubmit.co/dennyborgespa@gmail.com" method="POST">
        
        <input type="hidden" name="_subject" value="Notary Membership Cancellation Request">
        <input type="hidden" name="_captcha" value="false">
        <input type="hidden" name="_next" value="https://dennyborgespa.com/thank-you">

        
        <label for="name">Full Name</label>
        <input type="text" id="name" name="Full Name" placeholder="John Doe" required>

        <label for="email">Registered Email</label>
        <input type="email" id="email" name="Email" placeholder="email@example.com" required>

        <label for="plan">Select Membership Plan</label>
        <select id="plan" name="Membership Plan" required>
          <option value="">-- Choose your plan --</option>
          <option value="Basic Plan">Basic Plan</option>
          <option value="Advanced Plan">Advanced Plan</option>
          <option value="Professional Plan">Professional Plan</option>
          <option value="Elite Plan">Elite Plan</option>
        </select>

        <label for="reason">Reason for Cancellation (optional)</label>
        <textarea id="reason" name="Reason for Cancellation" rows="4" placeholder="We'd appreciate your feedback..."></textarea>

        <button type="submit">✅ Submit Cancellation</button>
      </form>

      <p class="note">
        Your request will be processed within 24 to 48 hours.<br>
        A confirmation email will be sent once the cancellation is completed.<br>
        Cancellations stop future renewals, but no partial refunds are issued. <br>
Need help? Contact us at: support@dennysborgespa.com or Call Us at: 1-888-815-7782
      </p>
    </div>
    <div class="image-section"></div>
  </div>
</body>
</html>

Denny Borges PA