Aftermarket Product Cancellation Request Date* MM slash DD slash YYYY Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email Address* I wish to cancel my aftermarket product(s) checked below.* Warranty (Extended Service Plans) Gap Theft Protection Maintenance Booklet VIN* Year, Make, Model* Current Mileage* Date of Cancellation* MM slash DD slash YYYY Reason for Cancellation*Dealership Purchased From* NOTE: If vehicle still has a lienholder, any cancellation refund will go to the lienholder. Maintenance booklets must be turned into dealership in order to be cancelled. Please fill out this form with as much information as possible to expedite refunds. All cancellations will be processed within five business days, and refunds can take up to four weeks to be refunded to individual or lienholder.•If sold to an individual, please include a copy of the Bill of Sale. •If sold to a dealership, please include Trade Odometer Statement. •If refinanced loan, please include the Paid in Full Letter. Drop files here or Select files Accepted file types: pdf, eps, tiff, jpg, png, doc, docx, xls, xlsx, Max. file size: 50 MB. The acceptable file formats are .pdf, .eps, .tiff, .jpg, .png, .doc, .docx, .xls, and .xlsx.Electronic Signature* By clicking here, I confirm the information given on this form is accurate to the best of my knowledge, and agree to all terms and conditions.CAPTCHA Δ