Use the form below to cancel your Gold Membership when you have signed up with any of the following payment methods.

• Sofortbanking
• iDEAL
• Bancontact
• Bank Transfer
• Credit Card
• Giropay

Name

Login Name (if you don't have you need to fill in n.a.)

Payment method

IBAN:

Creditcard details
/

Paid amount

Email address

Remarks