Pixelgate Networks Internet, Network, Computer Solutions for Business

Check your Email:

Services Cancellation Form

All account Cancellations require a 30 day notice. The effective date of this cancellation notice is this date, provided that a signed form is received at Pixelgate, via US mail or FAX, within seven (7) days of filling out this form. Provided that Pixelgate has a current email address, you will receive a verification from Pixelgate by email when the signed form is received. Please ensure that the provided email address is correct and legible. Do not assume receipt of this cancellation request if you do not receive a verification. Please keep a copy of the generated form for your records. Account Cancellations must be initiated and signed by the legal contact on file with Pixelgate - No Exceptions.

All Equipment, including DSL Modems MUST be returned to Pixelgate within 7 days of this notice. Any equipment not returned to Pixelgate will be subject to a $99.00 Equipment fee due prior to cancellation of service.

Contact	Information:
Full Contact Name (must be contact name on file with Pixelgate)
Company Name:
Account No.:
Address:
City:
State/Province:
Zip Code:
Phone Number:	- -
Fax Number:	- -
Email Address:
Service to be Cancelled:
Website Hosting - Website Address: http://
Internet Access, Please Check Service Received: High Speed Wireless DSL Service Dial Up Service T1 Service
Remote Backup
Managed Servers
Reason For Cancellation Here at Pixelgate we value you as a customer. In an effort to consitantly improve our practices please let us know why you are cancelling your service with us.

Once you press the button below, you will be brought to a page that you must SIGN and RETURN to Pixelgate via US mail or by Fax.