ALL CANCELLATIONS ARE FINAL. COVERAGE CANNOT BE REINSTATED FOR ANY REASON. SELLING DEALER IS RESPONSIBLE FOR ALL REFUNDS.

Cancellation Request Form

To file a cancellation fill out this online form and submit OR download the form in PDF format and follow instructions printed on form.
[trident_form name=”cancellation”]
Cancellation Procedures A cancellation request must be received in or our office within 30 days of the requested cancellation date to be processed without penalty. All incomplete requests, missing information or support documentation, will be returned unprocessed and will delay refund. All cancellation requests should be faxed, e-mailed or mailed from the dealer and will be processed in order by date received. A $50.00 cancellation processing fee will be assessed on all cancellations. All refunds are sent to the dealership unless the dealership is out of business.
All cancellation requests require the following:
  1. A legible enrollment form (contract) with the enrollment price, the terms in months and contract number.
  2. A complete cancellation request form.
  3. If the cancellation is due to:
    Customer Request: We must have the customer’s signature or a letter from the customer requesting cancellation. The signed document can be a cancellation request form.
    Total Loss: Any document from the primary insurance company or lien holder stating total loss, or customer signature.
    Repossession: A copy of the repossession letter from the lien holder is required.
    Vehicle Trade: An odometer statement or a cancellation request signed by the customer. A customer’s signature must be original.
    Voided Sale: A voided contract may be mailed or faxed with “VOID” written on the contract. We will void the contract and issue a full refund as long as the request is received within 30 days of the contract date.
PLEASE ALLOW 3 TO 4 WEEKS PROCESSING TIME.