Submit information for accounts review

This form is for former clients whose accounts have been cancelled. If you have been directed to this form and you have material information that would enable us to reconsider your account status, please complete the form below. You should provide supporting information in the form of uploaded documents.

In almost all cases you should obtain the services required from another organisation, and not to complete this form. Should you choose to complete this form, please ensure that your submission is complete and truthful. Do not omit any information, and ensure that you complete each field.

Incomplete submissions will not be processed.

Information about yourself

Please provide your natural name and the contact email address under which your account is registered.

Your full name

Your e-mail address

Afrihost account number

Information about the service

Please provide information about the Afrihost service that you would like us to review.

Name of service

Please state what this service is used for. We want to know why it is that you operate this particular web site, connectivity service, server or facility. Your answer should state specific details about the content the service handles, who the users and communication partners are, and what kind of communications and processing are involved:

What do you use this service for?

Your contact information

Please submit all of the information below. In the case of a company, please provide the details of a company officer.

Land line contact number

Physical address

Postal code for physical address

Failed payment details

Please provide complete details about the payments which have failed. We want to fully understand how you were authorised to use these account details, and what went wrong.

Bank account number for failing debit order

Bank branch code for failing debit order

Failing debit order account holder identity document

Photograph of the account holder holding his identity document

Failing debit order account statement

Please explain how it is that collecting payment from this account encountered problems and what steps were taken to resolve this

New payment details

Please provide complete details about the new payment arrangement which you will be making:

Type of account

Mastercard/VISA card Debit order on bank account

New payment details account number

New payment details branch code

New payment details account holder identity document

New payment details account statement

Please explain how these new payment details will address the trouble experienced

Motivation

Please provide a motivating statement for your review application. If there are relevant matters that have not been addressed in the above questions, please document those matters here.

Motivating text explaining why this review should be considered favourably.

Human check

Submit account documentation and information