Kwik Net - Dial up networking

Thursday, 8 January 2009

Kwik Net account cancellation form:

If you would like cancel your Kwik Net account please complete the following form.

* indicates required fields.

Kwik Net User Name:*
Password:*
Email address:* (not Kwik Net address)
Full Name:*
Physical Address:* (not P.O Box)	Address Suburb City
Daytime Contact Ph:*
After Hours Contact Ph:*
Declaration:	I declare that I have the authority to close this account, and can confirm all payments made to Kwik Net prior to this closure request will be honoured by me or any other third party who has made payments on my behalf. I personally guarantee and accept liability for, and undemnify Kwik Net against, any costs or expenses occured in recovering dishonoured payments or refunds paid and subsequently found to be invalid.
I have read and understand this declaration.*
Reason for Closure:*
Comments:
Requested date of closure: (30 Days from today by default)*
The information given in this Kwik Net account closure request is true and correct to the best of my knowledge, information and belief.
Click here to accept

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