Authorization to Add/Modify Accounts

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Letter of Authorization

To authorize the agent (s) below to perform the necessary duties and responsibilities to make changes to your Internet and hosting services. I understand this does not preclude our company from acting on its own behalf at anytime during this process. Please print the following form, complete the information and either email it to: support@nstci.com or fax to 281.240.7377.

Thank you!

I authorize the following agent (s) from this day forward to add and modify accounts. I also understand it is my obligation to let you know if changes are to be made to my authorized agent information:

ADD AGENTS BELOW:

Agent Name & ________________________

REMOVE AGENTS BELOW:

Agent Name & ________________________

Changes being made to account on this request: ______________________________________________________

______________________________________________________

_______________________________________
Company

______________________________
Authorized Signature of Customer

______________________________________
Name and Title

_____________________________________
Address

_______________________________________
City, State, & Zip

____________________________________
Date

______________________________
Main Telephone Number

______________________________
Additional Telephone Numbers

______________@________________
Email Address

PLACE COMPANY LOGO HERE