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Internet Cancellation Form
Intermax
Internet Cancellation Form
**Please be advised, a 30 day notice is required to cancel your internet service.**
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Account # (if known)
Name
*
First
Last
Reason for cancellation
*
Seasonal Hold (there is currently a $15/mon admin fee for months service is turned down)
Moving home
Changing service providers
No longer require service
If switching providers may we ask who?
Contact Number
*
Your contact telephone number
Email
*
Service Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
When would you like to terminate service? (date?)
*
Do you have one of our routers?
*
Yes
No
Please be aware that if you have one of our routers then it will need to be returned to our office within 3 days of service termination.
Signature
Clear Signature
Submit