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.
Attention:Accounts Administrator
Intertech Country
93 Commercial
Street West
Mount Gambier, SA 5290
re: Cancellation of Account
(please
note: you must be the primary account holder in order to canel your account)
I, ........................................................... ................................
(account holders real name)
wish to cancel my Internet Account by
giving you 30 days notice as specified in your Terms and Conditions.
http://www.icisp.net.au/conditions.html
(Please Print information)
My username is: .............................................@icisp.net.au
My
password is:...................................................................
My address is:......................................................................
City/Town..........................................................
State:............
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: / /
form
taken and checked by: bs - es - ts - gb- jm - tj
amount owing at close of account $