Cancellation Request Form

Cancellation Request Form

Must be filed through the selling dealer or lender. Forms submitted by all other parties will be rejected automatically.
DealerLender
Contact Person*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Customer full name*

First NameLast Name
VIN Number (Required full 17 digits validation)*
Cancellation Reason*

Loan PayoffRepossessionTotal LossCustomer RequestContract RewrittenDefault on LoanIssued in ErrorVehicle SoldVehicle Traded InVehicle StolenTotal LossDeal Unwound
Cancel Date *

MonthDayYear
Date
Cancel Mileage*
Contract Number*
Selling Dealership*
Required Documentation Based on Cancellation Reason

Loan Payoff → Upload Lienholder Payoff Letter
Repossession → Upload Repossession Letter
Total Loss → Upload Total Loss Letter
REQUIRED FIELD MUST UPLOAD DOCUMENTATION TO PROCEED*

Cancelof
UPLOAD ANY RELEVANT DOCUMENTS.

Cancelof
The only instance in which a customer’s signature is required is when the cancellation is being requested directly by the customer. For all other scenarios—such as loan payoff, repossession, or total loss—the appropriate supporting documentation from the lienholder, dealer, or insurance provider must be provided. Please note that failure to upload the required documentation or to complete the form in full will result in delays to processing and may potentially invalidate the cancellation request.
Customer Signature

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Dealer Signature*

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Todays Date*

MonthDayYear
Date
Legal Attestation Statement

By submitting this form, I hereby certify that all information provided is true, correct, and complete to the best of my knowledge. I further acknowledge and agree that my electronic signature shall have the same force and effect as a handwritten signature, and that Ascent Administration may rely upon this submission as an official request for cancellation. I understand that providing false, incomplete, or misleading information may result in denial of the cancellation, delay in processing, and/or legal liability.
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