888.361.9611 P.O. Box 457, Mahwah, NJ 07430
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 d ate.