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Thank you for your request.  Please print out and complete the Change Request Form
below. Sign and fax form to 770-603-9177

First Name: ___________________ Last Name: _____________________________

Business Name: _______________________________

Address: _____________________ City: ____________________ State: __ Zip: ______

Phone: _______________ Fax: ______________ Other: ________________

Email Address: _____________________________________

Website Address: _________________________________________

In order to make the HTML changes we will need your user name and password
(No one can make changes to the site without this information)

User Name: ___________________

Password: ____________________

I authorize Korrect Technology, Inc. to access my website and make changes or
upgrades to the above listed website. 

__________________________________________    Date: ___________________
Signature of Owner or Authorized Gatekeeper
for the above listed Website

 Please don't hesitate to call us @ 770-603-0905 if you have any questions.



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Korrect Technology, Inc.