Contractor Details
Contractor Lienholder Details
Dealer Details
Dealer Lienholder Details
Current Mileage must be provided at the time of cancellation request
I hereby request cancellation of my Extended Service Contract (“Contract”) described above. In consideration of this cancellation, I do hereby release the Service Contract Provider (“Dealer”) and the Service Contract Administrator (“Administrator”), and I agree to hold the Dealer and Administrator harmless from any and all claims, demands, actions and payments on account of the Contract, except for the refund that will calculated per the cancellation terms on the Contract. I further understand and accept that this cancellation will completely VOID all protection provided by the contract and cannot be reinstated for any reason after the cancellation date.
Cancellation Email:

Dealer must submit all required cancellation paperwork: Cancellation Request Form, Copy of Contract and any other supporting documents to our office within 30 days of Cancellation to be processed without penalty. All incomplete requests, missing informationor supporting documents will be returned unprocessed and will delay refund. Please allow 4-6 weeks to receive cancellation refund.