Policy Request for Cancellation

Please check box before continuing: *

I understand cancelling product will not result in my payment changing with my lien holder if there is still an open loan

Please check box before continuing: *

I understand if there is an open loan the cancellation amount will go to my lien holder and be placed to the unpaid balance

Please check box before continuing: *

I understand the processing time for this cancellation is 4-6 weeks

Which Cable Dahmer location did you buy your vehicle and/or product from? *

Location

Customer Name *

First Name

Last Name

Email Address *

Phone Number *

Phone Number (555-555-5555)

Address *

Street Address Street Address Line 2 (Optional)

City

State / Province

Zip Code

Vehicle Year, Make, and Model *

Vehicle Vin *

Vehicle Vin

Is the loan paid off? *

Loan Paid
Original lien holder if applicable Account Number

Reason for cancellation? *

Reason
Date Traded Sold to Date paid off Date of Total Loss Date Requested
Date Paid Off

Upload Documentation

Please upload documentation that includes what vehicle was traded as well as the trade date and mileage.

Please upload documentation that includes what vehicle was totaled as well as the loss date and mileage.
If the loan is paid off, please upload the lien release or paid-in-full letter from the bank.

Please upload documentation that includes the lien release and the date paid in full.

Please upload proof of mileage documentation
If the loan is paid off, please upload the lien release or paid-in-full letter from the bank.

Do you have any contracts purchased through Line 5/SPP Program you would like to cancel?

Contracts Cancel A

Contracts purchased through Line 5/SPP program? *

Centurion Shield

Ultimate Protection Bundle

Cable Dahmer Secure

Vehicle Service Contract

Tire & Wheel

KarrGuard Choice

KarrGuard Windshield

SWAT

Maintenance

Do you have any contracts purchased through your loan you would like to cancel?

Contracts Cancel B

As of 7/1/24, Maintenance contracts purchased on or after that date are cancellable.
Which cancellable contracts through your loan would you like to cancel? *

Centurion Shield

Ultimate Protection Bundle

Vehicle Service Contract

Tire & Wheel

KarrGuard Choice

Gap

Maintenance

Please leave any additional comments:

Additional Comments

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