Change Contact Information
Authorization Form

Please complete, print, and then fax this document once it has been signed and (if possible) notarized to:

GKG.NET, INC. • FAX: 281-617-5825

This document must be signed by the person named as the registrant contact for this GKG username. If there is a business or organization noted in the Organization Field, then the document found here: Change Username Form must be signed by an authorized agent of the Business or Organization.

Authorization to Change Contact Information

Please review all of your information in this document before printing.

Support Ticket No. (RT#):  

GKG Username:  

I am the owner of this GKG Username or I have authorization from the owner of this GKG Username to make any changes necessary for this username. If a Business or Organization is listed, I have authorization from this organization to make changes to this GKG Username, on their behalf.

Please make these changes to the username listed above:

Organization:
First Name:
Last Name:
Address:
City:
State/Province:
Zip Code:
Country:
Telephone:
Email:

I authorize GKG.NET representatives to charge the $15.00 administrative fee to this credit card:

Credit Card Number:

Expiration date: CVV: (3 digit number on the back of card.)
Name that appears on the credit card:
Billing Information
Address:
City:     State:     Zip:
X  
 Date:  
Signature

With this signature I authorize you to charge my credit card the $15 administrative fee required to process this document. I also confirm that I have proper permission to make this change to this username. I also understand that administrative fees are non refundable. I acknowledge and accept the terms of the GKG Services Agreement found at this address:

http://www.gkg.net/policies/serv_agree.html

I also understand that any associated domains may remain on "Registrar Lock" for up to one year, at the full discretion of GKG personnel, to protect the domain holders and ourselves against fraud.

Written Name: Tel. No.:

Email:

Please print this document after filling out all of the necessary information, sign it, have it notarized (if possible), and then fax it this number in the US:
281-617-5825

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