RebatesRock.com WebHosting Refund Verification
Form
Your Refund Is Ready!
Please send us the following information for an immediate
refund. By submitting this information you warrant
to us that you have purchased a WebHosting account
through our signup
page.
You further agree to NOT close any accounts that
were purchased in conjunction with this promotion
for a minimum of 60 days.
Name:
Address 1:
Address 2:
City : State: Zip:
DayTime Phone
EMail
Address :
What
Domain Name you are using with this promotion? :
Which
WebHosting company did you select?
What is the User Name you are using with this Web Host?
What
is the amount of the refund you are expecting?
Do
You want your refund sent by PayPal or Check?
PayPal
Check
Enter any additional information or special instructions in the space below.
Click the Submit button to send the data. Click the Reset button to start over .
Clicking
Submit and sending this form is your express authorization
for us to pay you an INSTANT REFUND. You agree that
by accepting an Instant Refund you will NOT close any
accounts associated with this promotion for a minimum
of 60 days. |