I hereby request that the personal information collected by Xanga.com concerning my child be deleted. I understand that this will result in my child’s account being shutdown.

Child’s Full Name (print):
_______________________________________________________________

Child’s Xanga Username (mandatory for successful shutdown):
_______________________________________________________________

Child’s Birthday:
_______________________________________________________________

Parent’s Full Name (print):
_______________________________________________________________

Parent’s Relationship to Child:
_______________________________________________________________

Parent’s Address

_______________________________________________________________

_______________________________________________________________

Daytime Telephone:
_______________________________________________________________

Evening Telephone:
_______________________________________________________________

Email:
_______________________________________________________________

ACKNOWLEDGMENT AND REPRESENTATIONS
In signing this Parental Request form, I hereby acknowledge and represent that I
(a) am over 18 years of age and of sound mind;
(b) am the parent or legal guardian of the child named above.

Parent Signature:
_______________________________________________________________

Date:
_______________________________________________________________

FORMS RETURNED WITHOUT ADDRESS AND PHONE NUMBER WILL NOT BE ACCEPTED

Please print and complete the form above.  Then, mail or fax the completed form to the contact information below.  Xanga will respond within two business days:

Xanga.com, Inc.
Attn: Parental Deletion
P.O. Box 500 Midtown Station
New York, NY 10018

or fax to : (917) 591-9200