Change of Service

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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 Podiatry Content Connection ("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*
Invalid Input! You cannot back-date cancelations.
(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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I want PCC to host my website*
If you answered 'Yes' to keeping your website, we can continue to host your site on our servers for $30/month, billed every six months. If you are interested in that, select 'Yes'. If you instead are planning to move the website to a new host/server, select 'No'.
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Reason for Cancelation*
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