Reduce Churn with a Cancellation Feedback Form

Collect cancellation reasons and retention insights from departing subscribers to improve your software and reduce customer churn effectively.

Use This Template Free Preview

Umber theme

formbuilder.ai/f/software-subscription-cancellation-reason-customer-retention-feedback-form

Software Subscription Cancellation Reason & Customer Retention Feedback Form

Your Full Name

· · ·

Account Email Address

· · ·

Company / Organization Name

· · ·

Submit

The Software Subscription Cancellation Reason & Customer Retention Feedback Form helps SaaS companies and software vendors understand why customers leave and what could have been done to keep them. By capturing structured feedback at the moment of cancellation, you gain actionable data to improve your product, pricing, and customer experience.

This template is ideal for SaaS founders, customer success teams, and product managers who want to minimize churn. It collects essential details such as subscription plan, tenure, primary cancellation reasons, competitor alternatives, satisfaction ratings, and open-ended feedback—giving you a complete picture of the customer's departure journey.

With built-in retention prompts asking whether specific changes or offers might reverse the decision, this form doubles as a lightweight retention tool. Deploy it in your cancellation flow to turn a lost customer moment into a valuable learning opportunity and potentially win back subscribers before they walk out the door.

3 Pages

19 Questions

~6min To complete

Free No credit card needed

Field types Single Choice ×3 Long Text ×3 Dropdown ×2 Yes / No ×2 Full Name Email Short Text Date Multiple Choice Star Rating Likert Scale NPS Score termsandconditions

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Account & Subscription Details 6 questions

Cancellation Request & Feedback

We're sorry to see you go. Please take a moment to share your experience so we can improve our service. Your feedback is invaluable to us.

1 Your Full Name * Full Name

2 Account Email Address * Email

3 Company / Organization Name Short Text

4 Subscription Plan * Dropdown

5 Subscription Start Date Date

6 How long have you been a subscriber? * Dropdown

Page 2 Cancellation Reasons & Experience 6 questions

Tell Us Why You're Leaving

1 What is the primary reason for cancelling? * Single Choice

2 Are there any additional reasons? (Select all that apply) Multiple Choice

3 Please describe your experience in more detail Long Text

4 Overall satisfaction with the product * Star Rating

5 How would you rate the following aspects? * Likert Scale

6 How likely are you to recommend our software to others? * NPS Score

Page 3 Retention & Final Thoughts 7 questions

Before You Go

1 Would any of the following change your mind about cancelling? * Single Choice

2 Would you consider returning in the future if improvements were made? * Yes / No

3 Which competitor or alternative are you switching to? Single Choice

4 What could we have done differently to keep you as a customer? Long Text

5 Any final comments, suggestions, or feedback for our team? Long Text

6 May we contact you for a brief follow-up conversation? Yes / No

7 I confirm that I wish to proceed with the cancellation of my subscription and understand this feedback will be used to improve the product. * termsandconditions

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.