Service Cancellation Form - DynamicNet, Inc.

Company Name*

Company name under which we bill you for our services?

Your Name*

First Last

Your Name

Your Phone Number*

Your Phone Number

Email Address*

Enter Email Confirm Email

Email address of primary account holder

Account ID:

Website*

Web site under which we bill you for our services. Example http://domain.com

Cancellation Date*

Date to Cancel our services - please note our contract overrides this date if you put in a date earlier than the contract allows.

Reason for Cancellation*

Please let us know why you are cancelling

I understand that my files will be completely deleted on the requested cancellation date and that if I have any additional packages within this account they will also be deleted. I also understand that if I pre-paid 12 months for my account, and have not completed a 12 month term, I will be charged at the regular monthly rates for the service I have received, and refunded the difference minus my current billing month. I understand that I am required to give 30 days advance notice for cancellation; and if the cancellation date I entered is less than 30 days from today's date, I will be responsible for paying through the entire 30 days. If my account has been active 15 days or less, I am eligible for a full 100% refund. To receive this refund I must specifically request it within my above comments. If I have other accounts with Dynamic Net, Inc. my refund will be applied as a credit toward my other account(s). Additionally, if I currently have a balance owed to Dynamic Net, Inc., that is not covered via my refund, I understand that I am still responsible for submitting a payment for the full amount owed.

Fine Print Understanding*

I understand the above fine print

I understand the above fine print