Use this form to request cancellation of eligible protection products purchased with your vehicle.

Submitting this form starts a cancellation review. It does not guarantee that a product is cancellable or that a refund is due. Eligibility is governed by the product agreement and applicable law. 

CUSTOMER INFORMATION

VEHICLE AND CONTRACT INFORMATION

PRODUCTS REQUESTED FOR CANCELLATION

CUSTOMER AUTHORIZATION

I certify that I am the purchaser or authorized owner. I authorize the dealership and product administrator to review this request. Any refund may be prorated and may be sent directly to the lender if a balance remains.