Policy Cancellation Request

Policy Cancellation Request

Please ensure form is filled out completely (all lines, signatures, & initials) and attach all necessary documents. Cancellation Processing my take 4-6 weeks.
Your Name*

First NameLast Name
Your Location*

Pat McGrath Dodge CountryMcGrath Buick GMC Cadillac KiaMcGrath VW of MarionPat McGrath ChevylandMcGrath VW of DubuqueDavenport Used Car SuperstoreMcGrath Ford HyundaiMcGrath Chevrolet of DubuqueMcGrath Toyota of Iowa City
Your Email*
example@example.com

Customer Information
I hereby request cancellation of the herein-mentioned policy(s In consideration of this cancellation, I do hereby release and forever discharge the Lender/Dealer and I agree to hold the Lender/Lessor and Dealer harmless from any and all claims, demands, action and payment on this addendum, except for partial refund of the charge.
Cancelled By:
Customer Signature*

Clear
Customer Printed Name*
Witnessed By:
F&I Manager Signature*

Clear
F&I Manager Printed Name*
Customer's Current Address*
Comments
Should be Empty:

Original Deal Information