Cancellation Request Form

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Fields marked by * are required
* Client Name :
Server Host Name :
* Primary IP :
* Root Password :
* Email :(your primary email address used for billing)
Secondary Email :
* Date to Cancel Server On :
Last Payment Transaction Number or ID : (Paypal or other for verification of payment)
wht :
msn :
yim :
icq :
aim :
Notes/Instructions :