Cancellation Form

Email Address*	Email address used to register your web hosting account. Our technicians will use this email address for correspondance and to update you on the progress of your request.
Domain Name*	Example: tucandesigns.com
Hosting Username*
Hosting Password*	We use this information in order to validate your credientials as the account owner. A generated request without the correct username/password will be ignored. Account owners will be notified of the failed request.
Why you wish to cancel?
Hosting Plan

		By checking this box you give us permission to terminate the plan selected above as soon as you submit this form.