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Cancellation Form
ALL fields are Required. Each required field must be filled out in order for your request to be processed.
In order to process your request, we will need to verify your identification. You will find the information in the account information email that you received from us when your account was originally setup.
Client Code
Support Code

Please Choose:

Cancel only Cart32 Account

Cancel only Website Account

Cancel Entire Account

Domain Name
First Name
Last Name
Billing Address
City
State
Zip Code
Phone Number
Email Address
Last 4 digits of credit card number
Reason For Cancellation  

Signature		  X_____________________________________  Date  ___________

Print out and Fax the completed form to 314-635-9959 with your signature, we MUST have the signed copy to ensure proper cancellation and credits if any.  You can also mail this form to the following address:

McMurtrey/Whitaker & Associates, Inc.
300 S Jefferson, Ste. 205
Springfield, MO 65806
Attn:  Billing Department