Warrantech Cancellation Request

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Contract Cancellation Directions:
‌‌1. Dealer must complete and submit this "Cancellation Request" form.
‌2. Once this form is submitted, an email will be sent to the "Customer Email" provided below.
‌3. If supporting documentation is required, a "Supporting Documentation" email will be sent to the Dealer Representative.

‌4. Once the forms are submitted and all supporting documentation received, the cancellation will be processed.

Dealer/Customer Information

Dealer Code

Customer Name

Dealer Name

Customer Street Address

Dealer Street Address

Customer Zip/Postal Code

Dealer Zip/Postal Code

Customer State/Territory/Province

Dealer State/Territory/Province

Customer Email

Dealer Representative Name

Dealer Representative Email

Cancellation Information

Contract Number

Cancellation Date

Vehicle Identification Number (VIN)

Cancellation Mileage

Program for Cancellation

Brand Name

Reason for Cancellation

Cancellation Program

Refund Recipient (FLORIDA DEALERS MUST FILL THIS OUT)

Cancellation Consent

You certify that the customer named on the contract has requested cancellation and agree to indemnify us for all liability, including but not limited to claim/loss payments, flowing from a customer disputing cancellation or a finding from a governmental or judicial authority that cancellation was erroneous or ineffective.

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