autotech protect transfer form
DESCRIPTION
ÂTRANSCRIPT
Contract Information
Contract Number Effective Transfer Date Vehicle Mileage on Transfer Date
Vehicle Year Vehicle Make and Model Serial Number (VIN)
Contract Holder Information
Contract Holder Name (s) Phone Number
( )Address City State Zip
Date on Which Vehicle Ownership Changed
Transferee Information
Transferee Name (s) Transferee Phone Number( )
Transferee Address Street City State Zip
The Contract Holder requests that the identified Service Contract be transferred to the Transferee
on the date indicated above. The Contract Holder and the Transferee agree that the information on
this request is correct.
_____________________________________ ____________________________________________Contract Holder Signature Date Transferee Signature Date
Please send (1) the completed Request to Transfer Form (2) all copies of maintenance records for the vehicle
(3) proof of transfer of ownership (4) and payment of the transfer fee as indicated within your service contract
made payable to American Colonial Administration, LLC to the above listed address
Transfer requests must be submitted within thirty (30) days of the vehicle ownership change.
Requests to Transfer received by the Administrator after this time period, will be declined.
P.O. Box 2085
Dublin, Ohio 43017
Tel: 855.807.2885
Email: [email protected]
Fax: 866.834.1740
Service Contract Request to Transfer
Effective 2/1/16
Address All Correspondence To:Attn: Administrative Offices