Transfer Request Form

Return Documents to: DKP Administration, Inc. ATTN: CONTRACT TRANSFERS 4925 Boonsboro Road, Suite 238, Lynchburg, VA 24503 Phone: 833-357-2366

Important: Only the original owner may request a transfer. Transfer is not permitted if vehicle is sold or traded to or through any automobile dealer, auto broker, auto auction, or financial institution. Transfer requests are only permitted once and must be received within 30 days of change in vehicle ownership.

Original Owner

Original Owners Name(Required)

First Last

Original Owners Email(Required)

Original Owners Phone(Required)

Original Owners Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

New Owner

New Owners Name(Required)

First Last

New Owners Email(Required)

New Owners Phone(Required)

New Owners Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Vehicle Information

Vehicle ID Number(Required)

Vehicle Make/Model/Year(Required)

Vehicle Odometer (Hours for PWC/ATV/UTV)(Required)

Vehicle Title Transfer Date(Required)

Contract Numbers(s):

Please list all Contract Numbers below. Separate with either new line or a comma.

Transfer requests will not be processed without the following supporting documentation.

Transfer Fee for each applicable contract (Required). Check payable to: DKP Administration, Inc. Or .

Bill of Sale

Copy of a Bill of Sale to the Assuming (New) Vehicle Owner listed above, showing transfer date and vehicle mileage at time of sale.

Max. file size: 512 MB.

Copy of the Contract

Max. file size: 512 MB.

Maintenance Records

(For Vehicle Service Contracts Only.) Copy of All Maintenance Records showing that the manufacturer’s required maintenance has been performed pursuant to the terms of the DKP VSC.

Max. file size: 512 MB.

Signature(Required)

Date Signed(Required)

Transfer Request Form

Original Owner

New Owner

Vehicle Information

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