CONTACT INFORMATION: (All fields with an asterisk* are required)

Your Name:
Name of Domain to be deleted:
Username:
Password:
Your Email Address:

Additional Comments:
(Please include any additional comments in this area, including the reason for leaving.)

Please review this form before submitting. Upon submitting, you will receive a confirmation of your request via email. If this cancellation is within 30 days of the date the account was activated, your credit card/checking account will be credited that months hosting fee.