cancellation request form Home / cancellation request form Product Cancellation Request Form Request To Cancel Protection Plan CommentsThis field is for validation purposes and should be left unchanged.Name(Required) First Last Phone(Required)Email(Required) Mailing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Reason For Cancelling?(Required)What is the Coverage You Are Requesting to Be Cancelled?(Required)VIN(Required)Last Odometer Reading(Required)Terms and Conditions(Required)Terms and Conditions – Cancellation of GAP, Vehicle Service Contract, and Vehicle Protection Plans By submitting a request to cancel a Guaranteed Asset Protection (GAP) Agreement, Vehicle Service Contract, or any other Vehicle Protection Plan (“Protection Plan”), the customer acknowledges and agrees to the following terms and conditions: 1. Cancellation Request All cancellation requests must be submitted in writing and are subject to approval by the applicable administrator and/or provider of the Protection Plan. Cancellation eligibility, refund amounts, and refund methods are governed by the terms of the original Protection Plan agreement and applicable state laws. 2. Refund Amount Any refund due as a result of a cancellation will be calculated on a prorated or earned basis, less any applicable administrative fees, claims paid, or other charges as permitted under the Protection Plan agreement and state law. No refunds are guaranteed. 3. Lienholder Payment If there is a remaining loan balance on the vehicle at the time of cancellation, any refund amount will be sent directly to the lienholder listed on the vehicle financing agreement. The refund will be applied toward the outstanding loan balance. If no lienholder exists, any eligible refund may be issued directly to the customer. 4. Processing Time The customer understands and agrees that the cancellation and refund process may take up to eight (8) weeks or longer from the date all required documentation is received by the administrator or provider. Processing times may vary based on lender, administrator, and provider requirements. 5. Forfeiture of Coverage and Rights Upon cancellation of the Protection Plan, the customer forfeits all rights, benefits, coverages, and claims associated with the cancelled Protection Plan, effective as of the cancellation date. No coverage will be available for repairs, losses, or claims occurring on or after the effective cancellation date. 6. No Retroactive Coverage Once cancelled, the Protection Plan cannot be reinstated, and no benefits will apply retroactively under any circumstances. 7. Customer Responsibility The customer is responsible for ensuring all required documents, including lender payoff information (if applicable), are accurate and complete. Incomplete or incorrect information may delay processing. 8. Final Authority The Protection Plan administrator or provider retains final authority regarding cancellation approval, refund calculations, and refund issuance. I accept the terms and conditions of this agreement and agree to comply with all related rules and policies. I understand that I may withdraw my consent at any time by contacting the organization, recognizing that doing so may affect my ability to continue with the related service or activity. I confirm that I have read and understood the terms outlined above.Printed SignatureI agree that typing my name below constitutes my legal electronic signature. Δ
