Change of Service

This form may not be filled out on behalf of any client. By submitting this form I am acknowledging that I am a client of PCC and wish to cancel a service.

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Name*
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Practice Name*
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Phone*
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Email*
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Date of Cancelation*
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(You cannot back-date cancelations.)

I want to keep the domain name*
I want to keep my domain name (e.g. www.footdoctor.com). (As long as there is no balance on your account, we will release the domain to you)
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I want to keep the website*
I want to keep my website (the files/images/content). If you are having your site redesigned, select "No".
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Reason for Cancelation*
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