Service Cancellation Form Company Name*Company name under which we bill you for our services?Your Name* First Last Your NameYour Phone Number*Your Phone NumberEmail Address* Enter Email Confirm Email Email address of primary account holderAccount ID:Website* Web site under which we bill you for our services. Example http://domain.comCancellation Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date 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 cancellingI 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