To cancel your account print out this form and
fill it in with your details and post it to the address shown
below.
Note:This must be sent
by Australia Post and cannot be faxed or emailed.
Any
received by fax or email will be invalid and will not be accepted as cancellation
of your account.
As per our
terms and conditions section 9.8 If you
cancel your account or move to another provider all of your account details
including your login username and password, email accounts and any information
will be deleted from our system during the monthly
billing/accounting cycle canellation period. We are
not obliged to inform you that all information (including email accounts) will
be deleted from our system after receiving your cancellation
form.
Attention:Accounts Administrator
Intertech Country,
2 Beech Street Mount Gambier, SA 5290
re: Cancellation of Account
Dialup [ ] - ADSL
Broadband [ ] - Wireless (USB) [ ]
(please
note: you must be the primary account holder in order to canel your account)
I, ........................................................... ................................
(account holders real name) (Please Print information)
wish to cancel my Internet Account by
giving you notice as specified in your Terms and Conditions.
http://www.icisp.net.au/conditions.html
My username is: .............................................@icisp.net.au
My
password is:......................................
(please
use the left side address
section if you are not moving. If you are moving to a new address, city, or
travelling around please fill in both address sections
|
Current Address Information |
New Forwarding Address Information |
|
|
|
|
My address is:.................................................. |
new address............................................... |
|
City/Town..........................................................
|
new city/town.............................................. |
|
State:............ Postcode:............... |
new state............. new postcode............... |
Drivers Licence No: ............................
Date of Birth: ...............................
Telephone: (0 ) .................................
Mobile: .........................................
Reason for cancelling account:
................................................................................................................................................................................
.............................................................................................................................................................................................................................................
As the primary account holder I understand that there are no refunds for unused portions of services, this includes fees paid in advance for Block Hours, ADSL, Dial-Up and Web Hosting services and that cancellation of my account does not remove my responsibility to pay all fees incurred up to and including the date of cancellation.
Signed.............................................................
Print name:.......................................................
dated this day: ................................................. office use: date received: / / : date account closed: / /