Cancellation Request Form

Company or Organization Name*

Officer's Name*

First Last

Officer's Title*

Email*

Website Address*

Please include the http://

Services to be Discontinued*

List all services to be discontinued. Services could be Web Hosting, SEO, Pay-Per-Click Managment, Domain Registration, IDX Services, Google Apps, etc.

Date to Terminate Services*

Cancellation Agreements*

I understand that all Services listed above, including all data, emails, reports, images and files will be deleted and unrecoverable following the “Date to Terminate Services”.

With exception of the WP Site Care trial period, I understand that thirty (30) days notice is required for all Service and Product cancellations.

I understand outstanding balances must be paid in order to effect this Cancellation Request.

I understand that SWG does not pro-rate monthly charges.

I understand that Southern Web, LLC makes no representation, warranty or guarantee regarding the use of the Product, functionality, image or software licenses with any other provider.

I understand that domains registered by Southern Web on behalf of the Customer must be transferred to another registrar following the submission of this Cancellation Request Form. Southern Web will not issue domain renewal invoices or sales receipts for any domains held Southern Web or its partners following the receipt of this Cancellation Request Form. Southern Web will provide transfer authorization codes to the client upon receipt of the cancellation request. All domains not transferred away from Southern Web's domain reseller account within thirty (30) days of the submission of the Cancellation Request Form shall become the property of Southern Web, LLC.

Officer's Signature*

Name

This field is for validation purposes and should be left unchanged.

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