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  • Zurich Cancellation Form

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    Karen Moore
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    This 3 sentence summary provides the key details about the contract cancellation form: The contract cancellation form requires information about the contract holder and selling dealer, details of the products and vehicle being cancelled, the reason for cancellation such as contract holder request or total loss, and signatures from the contract holder and dealer representative to process the cancellation request. Incomplete forms or missing documents will delay the cancellation process, so the form instructs the user to provide all required information and documentation for the cancellation to be processed.

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    This 3 sentence summary provides the key details about the contract cancellation form: The contract cancellation form requires information about the contract holder and selling dealer, details of the products and vehicle being cancelled, the reason for cancellation such as contract holder request or total loss, and signatures from the contract holder and dealer representative to process the cancellation request. Incomplete forms or missing documents will delay the cancellation process, so the form instructs the user to provide all required information and documentation for the cancellation to be processed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    68 views1 page

    Zurich Cancellation Form

    Uploaded by

    Karen Moore
    This 3 sentence summary provides the key details about the contract cancellation form: The contract cancellation form requires information about the contract holder and selling dealer, details of the products and vehicle being cancelled, the reason for cancellation such as contract holder request or total loss, and signatures from the contract holder and dealer representative to process the cancellation request. Incomplete forms or missing documents will delay the cancellation process, so the form instructs the user to provide all required information and documentation for the cancellation to be processed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Contract Cancellation Form


    To be completed and signed by the Contract Holder and the Selling Dealer
    Complete all sections of this form. Incomplete forms and missing documents will greatly delay the cancellation request.

    Contract Holder Selling Dealer


    Name Name
    Mel Rapton Honda
    Address Address
    PO Box 214537
    City State Zip Code City State Zip Code
    Sacramento CA 95821
    Phone Number Phone Number Fax Number
    916-514-4015
    Cancellation of coverage requested for the following products. Please check all that apply.
    (See product form for details and cancellation rules by state.)
    Vehicle Service Contract GAP Other
    Maintenance Security Guard
    Tire & Wheel

    Vehicle and Contract Information


    Date Contract Date Cancellation
    VIN Number Purchased Requested
    Vehicle Mileage at Vehicle Mileage
    Contract Purchase at Cancellation

    Loan Information
    Financial Institution paid in full? Yes No
    Indicate to whom the refund should be paid. If loan paid in full, include proof of payoff with the request.
    Name

    Address

    City State Zip Code

    Reason for Cancellation


    Please check one (1) of the following and attach required documents.
    Contract Holder Request-Attach Contract Holder copy of Contract. If unavailable, Contract Holder must put request in writing in the space below.

    Repossession - Attach copy of repossession papers from Financial Institution.

    Total Loss - Attach copy of Total Loss Report. (Not applicable to GAP coverage)
    Unwind - Attach Contract Holder copy of Contract and provide a brief explanation for flat cancellation in the space provided below.

    Other - Please explain in provided space below.

    Comments/Additional Information

    Signatures Required
    Cancellation Request must be signed by the Contract Holder and Dealer Representative, or include supporting documentation showing reason for cancellation.

    Contract Holder's Dealer's Representative


    Signature Date Signature Date

    Please provide completed cancellation form and all required documentation by utilizing any of the following methods:
    Mail: Zurich F&I Customer Service, PO Box 7922, Shawnee Mission, KS 66207
    Email: [email protected]
    Fax: (913) 664-3247
    Questions: Please call Toll-Free (888) 805-1594

    V23150KN (10/13)

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