Attachment Cancellation Request Form

The following contact hereby agrees and authorizes National Informaion Services (NIS) or its transfer agent to cancel the service indicated above. This authorization is dependent upon any financial obligations that are past due. Please contact the eServices finance department at 1-800-734-5561 if you have any questions concerning your account. Your account will be invoiced in the next billing cycle to reflect any charges that have not been paid prior to canceling, including any charges incurred for the month the cancellation was requested. All information contained on this form is strictly confidential.

* INDICATES REQUIRED FIELD

CONFIDENTIALITY NOTICE: NIS respects your privacy. All information you provide using this response form will ONLY be used by National Information Services and its affiliated resellers in order to process the information you’ve submitted. Your personal information will NOT be sold, rented, bartered, or otherwise transferred to other people who would send you unsolicited mail.

This form will be sent immediately via email. If you encounter any problems you can send email directly to webmaster@nationalinfo.com