portfolio - expresscancel.comexpresscancel.com/portfoliocancellationrequestform.pdf · form:...

Ancillary/Autocare - Portfolio, 25541 Commercentre Drive, Suite 100, Lake Forest, CA 92630 Phone: (800) 705-4001 VSCs - Portfolio, 14651 Dallas Parkway, Suite 502, Dallas TX 75254 Phone: (800) 335-8769 Form: Portfolio-Cancel rev. 01/2017 Portfolio Cancellation Request Form Contract Number (Required) Date of Sale Customer Name Dealership Address Address City State Zip City State Zip Year Make Model VIN (Required) Cancel Date (Required) Lender/Lessor Term Cancel Mileage (Required) Product (Example: VSC, Express 5, Key Replacement, GAP*) (Required) Reason for Cancellation (Required) Contract Selling Price to Consumer Any pending claims? Requested By (Print Name) Title Customer Signature Requested On Cancellations are processed according to the terms on the contract. *The GAP waiver is non-cancellable after a total loss (State/lender exemptions apply). All lender specific cancellations can be done online. Please log-in to our dealer portal to cancel contracts. For access, please email [email protected] Send this request to: Ancillary and Autocare Contracts: Email: [email protected] Fax: 949-727-0393 Vehicle Service Contracts: Email: [email protected]

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Form: Portfolio-Cancel rev. 01/2017

Portfolio Cancellation Request Form

Contract Number (Required) Date of Sale

Customer Name Dealership

Address Address

City State Zip City State Zip

Year Make Model

VIN (Required)

Cancel Date (Required)

Lender/Lessor

Term Cancel Mileage (Required) Product (Example: VSC, Express 5, Key Replacement, GAP*) (Required)

Reason for Cancellation (Required)

Contract Selling Price to Consumer Any pending claims?

Requested By (Print Name) Title

Customer Signature Requested On

Cancellations are processed according to the terms on the contract. *The GAP waiver is non-cancellable after a total loss (State/lender exemptions apply). All lender specific cancellations can be done online. Please log-in to our dealer portal to cancel contracts. For access, please email [email protected]

Send this request to: Ancillary and Autocare Contracts: Email: [email protected] Fax: 949-727-0393 Vehicle Service Contracts: Email: [email protected]

mailto:[email protected]

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