# Form of high service of lodging Web #
It is going to come to contract to a service of lodging Web. Please, it fills up all the fields of the discharge form. If it needs aid in the process it does not doubt in contacting to us by telephone to 9 02 52 02 52 (If it calls from outside Spain +34. 913 155 586) or by email to info@empirehosting.org.

Name of the dominion
To realize the registry Tariffs
Person of contact
Company
Address
Telephone
CIF/NIF
Population
Province
Country
Postal C.
Email
User (Control Panel)
Password (*)
How he knew us?
Regularity of the payment
Modes of payment: (It selects one of the following options):
1.
BANKING DOMICILIATION
Name of the holder
Organization
Office
D.C.
Account
2.
CREDIT CARD (nonresident in SPAIN.)
Type of Card
Name of the holder
Numeration
Month of lapsing
Year of Lapsing
Commentaries (optional)
Before discharging from the hospital, please it reads the terms of the contract
For any consultation or incidence in the discharge to contact with: info@empirehosting.org

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