BetterCheck Username*:
	BetterCheck Password*:
	Email Address Listed on the BetterCheck Account*:
	Name On Account - first and last*:
	Company Name on Account:
	Billing Address:
	Billing Address Line 2:
	City:
	State:
	Zip Code:
	Phone:
	Comments:
I authorize yourfavorite.com to cancel my BetterCheck account listed above and I understand that all setup fees and funds added to the account prior to cancellation are non-refundable under any circumstances. I understand that I am fully responsible for the security of my virtual terminal, my username, and my password, and I accept full responsibility for ALL transactions processed via my terminal or via direct link to my account. I agree to the full terms of service at the following URL http://yourfavorite.com/about/tos.htm, and I have taken the time to thoroughly read these terms of service and I agree with them. I also agree to the associated refund policy, abuse policy and privacy policy, and the fee structure regarding cancelled account, including phone charges, and reactivation, and by submitting this cancellation, I warrant that I fully understand all of these agreements.

---

I Agree