Edit, Download, and Sign the Cancellation Form for Service Agreements
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How do I fill this out?
Filling out this form requires precise information from both the customer and the dealer. Be sure to attach the original contract and any necessary documents. Follow the instructions carefully to ensure a successful processing of your cancellation request.

How to fill out the Cancellation Form for Service Agreements?
1
Complete all required fields on the form.
2
Attach the customer's original copy of the contract.
3
Indicate the reason for cancellation.
4
Send the completed form to the specified address.
5
Allow three to four weeks for processing.
Who needs the Cancellation Form for Service Agreements?
1
Consumers who wish to cancel service agreements may need this form.
2
Dealers who require documentation for refund processes need this form.
3
Vehicle sellers who have transferred ownership require cancellation for their agreements.
4
Finance companies involved in service contracts may need this form for record-keeping.
5
Individuals dealing with repossessions or total loss situations might require this form to process cancellations.
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Upload the Cancellation Form to PrintFriendly.
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Select the fields you wish to edit.
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Download the updated PDF for submission.

What are the instructions for submitting this form?
To submit the Cancellation Form, complete all required fields and attach the customer's original copy of the contract. Send the completed form to FWS/JM&A at P.O. BOX 8567, Deerfield Beach, FL 33443. It is recommended to retain a copy of the completed form for your records as submission confirmation. Additionally, consider following up with the dealer for any further concerns regarding the refund process.
What are the important dates for this form in 2024 and 2025?
Important dates related to the use of this Cancellation Form in the upcoming years may include expiration dates of service agreements, renewal reminders, and specific deadlines for filing cancellations with dealers or affiliated companies. Always check the terms associated with your service agreements for the most accurate information.

What is the purpose of this form?
The purpose of this Cancellation Form is to facilitate the process for customers wishing to terminate their service agreements. It clearly outlines the necessary steps and documentation required for a successful cancellation request. Additionally, it holds both the customer and dealer accountable by requiring necessary signatures and information.

Tell me about this form and its components and fields line-by-line.

- 1. Customer Information: Includes fields for the customer's name, address, and contact details.
- 2. Contract Details: Sections to provide the contract number and VIN of the vehicle.
- 3. Reasons for Cancellation: A checklist of possible reasons why the customer is seeking cancellation.
- 4. Signatures: Fields for both customer and dealer signatures to validate the request.
- 5. Submission Instructions: Guidance on how and where to send the completed form.
What happens if I fail to submit this form?
Failing to submit this form properly may result in delays in processing your cancellation request or even denial of the cancellation.
- Incomplete Processing: Your form may be returned unprocessed if required information is missing.
- Delays in Refunds: Without a properly submitted form, you may experience significant delays in receiving any owed refunds.
- Liability Issues: Failure to adequately fill out the form may result in issues with liability for remaining contracts.
How do I know when to use this form?

- 1. Canceling a Service Agreement: Use this form anytime you wish to cancel an active service contract.
- 2. Transferring Vehicle Ownership: Required when a vehicle is sold or traded, and the new owner needs different coverage.
- 3. Reporting Total Loss: Necessary in the event of theft or total loss of the vehicle.
Frequently Asked Questions
How do I fill out the Cancellation Form?
Complete all sections of the form accurately, and attach any required documents.
What should I do if I lose my contract?
You will need a letter from the dealer stating their responsibility for any unaccounted coupons.
How long does processing take?
Typically, you should allow three to four weeks for processing your cancellation.
Is there a specific submission address?
Yes, the completed form must be sent to FWS/JM&A at the address provided on the form.
What happens if the form is incomplete?
Incomplete forms will be returned unprocessed, so ensure all sections are filled out.
Can I track my cancellation request?
Tracking options may vary, so it is best to contact your dealer for updates.
What reasons can I select for cancellation?
Choose from several options provided on the form, including vehicle sold or repossession.
Do I need to sign the form?
Yes, both the customer and dealer need to sign the form to validate the cancellation.
Is there a fee for processing the cancellation?
Check with your dealer for any potential fees involved in the cancellation.
Can I use this form for different agreements?
This form is specifically for the FWS and/or GAP/TLP agreements.
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