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    * Order Number
    * Billing Name
    * Email Address
    * Domain Name
    * Username
    * Password
    * Is your account:

    1. Are you transferring your web hosting services to another hosting company?

    2. If you answered "yes" to question 1 which hosting company are you switching to?

    3. What is more appealing about their service?

    4. Why did you choose to leave DYNTEX?

    5. May a DYNTEX customer service representative contact you?

    Please type your full name AND email address in the box below. By doing so and submitting this form to DYNTEX you are agreeing to the terms, conditions and acceptable use policy previously set forth by DYNTEX. This is a binding document.

    *I AGREE to all items in the terms and conditions of use policy:

    This document will not be "signed" in the sense of a traditional paper document. To verify the contents of this form, the signatory must enter any combination of alpha/numeric characters that has been specifically adopted to serve the function of the signature, preceded and followed by the forward slash (/) symbol. Acceptable "signatures" could include: /john doe/; /jd/; and /123-4567/. For example: if your name is John Miller, you could type /John Miller/ below.

    *Signature: *Date:

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