Cancellation Form

WATCH FIRST - What you need to know about cancellation

Products Wishing to Cancel*

WarrantyMaintenanceGAP InsuranceTransfer to a new owner

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

VIN*

Found on the corner of your windshield or driver's door jam

Current Odometer*

In miles

Reason for Cancellation*

Do you have a loan on your vehicle?*

By signing below, I am acknowledging: (1) I have watched the video above. (2) I understand that if my vehicle has an outstanding balance with a financial institution the pro-rated amount will be sent to them and reduce my total amount owed, and I will not be receiving the monies directly. (2A) I also understand that the prorated cancellation credit will not reduce my monthly payment, but will help to pay off the loan sooner than the contracted completion date. (3) If the vehicle is paid off and there is no lien holder I understand that I will be receiving the prorated amount with 14-21 days of cancelling. (4) I understand that this process will take between 7-14 business days to complete. (5) I am authorizing the cancellation of the products identified above. (6) I am acknowledging that cancelling these products will result in a loss of coverage or benefit.

Additional Comments

Signature*

Request for Product Cancellation