|
I,
the undersigned, certify that I am the owner of this account and have
authority to make changes to the account. I, the undersigned, herby officially
and lawfully request for the cancellation of my service with Network Data
Center Host, operating under the trade name NDC Host (www.ndchost.com). I understand that my submission of this signed Service Cancellation
Request Form (SCRF) does not in itself cancel my service with Network Data Center Host. I
Understand that this form must be returned to me with a confirmed
cancellation number (CCN) and Signature of an authorized Network Data Center Host
representative. I understand that I
am bound to the cancellation terms of my contract, and that the execution of
such will take place upon my submission of this form. I understand that while
I’m not required to give a reason for cancellation, I am given the liberty to
do so below, and that this reason along with my contract, the Terms of
Service (TOS) and communication between myself (and/or company) and Network
Data Center Host may be used to fulfill the cancellation terms of my contract
which may include the collection of fees. As part of my contract and or the
Terms of Service, I am required to submit this form no less the 30 days from
my requested cancellation date, and I understand that I will not be
reimbursed for any prorated services and that cancellations in accounting
become effective on the first day of the next billing cycle.
|
Domain Name:
|
|
|
User / Server Name:
|
|
|
Account
/ Server Root Password:
|
|
|
Name on Account:
|
|
|
Billing Type:
|
|
|
Last 8 digits of CC# if applicable
|
|
|
Billing Address:
|
|
|
|
|
|
|
|
|
Reason For Cancellation:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Subscriber
Signature*
|
|
|
|
(below is for office NDC Host
Office use only)
|
|
NDC Representative:
|
|
|
Confirmed
Cancellation Number (CCN):
|
|
Date:
|
|
|
Signature*
|
|
Please complete this form and fax it to NDC for
cancellation of service. This form is required!
|