Cancel Coverage

Customer Name(Required)

First Last

Customer Address(Required)

Street Address Address Line 2 City State ZIP Code

Customer Email(Required)

Customer Phone(Required)

Selling Dealer Information

Dealership Name

Dealership Phone

Dealership Address

Street Address Address Line 2 City State ZIP Code

Cancellation Information

Year(Required)

Please enter a 4 digit number (YYYY)

Make(Required)

Model(Required)

VIN/Towable/Coach/Serial Number(Required)

Date of Cancellation(Required)

Odometer Reading at Time of Cancellation(Required)

Miles or Kilometers?

Miles

Kilometers

Reason for Cancellation(Required)

Customer Request (Customer Signature required; Date of Cancellation must be within 90 days of Current Date).

Loan paid in full (Submit Paid in Full notice from lienholder).

Sold Vehicle/RV/Machine (Customer Signature required; Submit Proof of Sale, if older than 90 days).

Traded in (Customer Signature required; Submit Trade documents, if older than 90 days).

Total Vehicle/RV/Machine Loss (Submit copy of Total Loss documents).

Repossession (Submit copies of Repossession Documents).

Other

Contract Number(s)(Required)

Please list each Contract Number below. Separate either by new line or a comma.

Submit Needed Documents

Please only submit needed documents. You can submit multiple documents here. We cannot process a cancelation until for requested documents are provided. Thanks.

Drop files here or

Max. file size: 512 MB.

In consideration of this cancellation, I do hereby release and forever discharge the original Seller and the Administrator, and I agree to hold the Seller and Administrator harmless for any and all claims, demands, actions and payments on account of the Contract, except for partial refund of the Contract charge. I further understand that any service charge indicated in the Contract may be subtracted for any refund of the Contract charge. I further understand that any service charge indicated in the Contract may be subtracted from any refund for which I qualify. I understand any Refund due will be paid to the lienholder in the event the loan has not been satisfied, and that I must notify the Administrator if the refund has not been received by me or credited to the Seller within sixty (60) days.

Customer(Required)

Date(Required)

Cancel Coverage

Selling Dealer Information

Cancellation Information

Make a Payment