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:
Please Choose:  Cancel only Cart32 Account.
 Cancel only Website Account.
 Cancel Entire Account.
Domain Name:
First Name:
Last Name:
Billing Address:
Zip Code:
Phone Number:
Email Address:
Last 4 of CC:
Reason for
Signature: X ________________________________ Date: ___/___/_____

Print out and Fax the completed form to 417-763-6908 with your signature, we MUST have the signed copy to ensure proper cancellation and credits if any. You can also email a signed copy of this form into or you can mail it to the following address:

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

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