Service Contract Cancellation Request Form
In the event that you wish to cancel a service contract that you purchased, please complete this form and submit it for processing
to the selling Dealer identied on your Contract or send it to Sonsio by email or postal mail:
• Email to [email protected]
• Mail to Cancellation Requests, PO Box 1658, Maryland Heights, Missouri 63043
Please refer to the Cancellation section within your service contract. If you reside in a state with specic laws regarding
the cancellation of this Contract, the specic laws of that state will apply as outlined in the State Changes and Disclosures
Addendum. For questions or cancellation quote, please call 855-912-2577 or send an email to [email protected].
CONTRACT HOLDER INFORMATION
Original Contract Holder Name:
Address:
City: State: Zip:
Phone Number: Email:
Vehicle Identication Number (VIN):
Vehicle Year, Make & Model:
Date of Vehicle Purchase: Date of Contract Purchase:
CANCELLATION DATE: If the cancellation eective date requested is 60 days or more prior to today’s date please include
Odometer Statement, Total Loss or Repossession Letter, etc.
Customer Requested Date: Trade/Sale Date:
Total Loss Date: Repossession Date:
VEHICLE FINANCE INFORMATION: Was the vehicle you purchased/leased nanced? Yes No
If YES, please provide the name of the Lender:
CONTRACT HOLDER’S AFFIRMATION OF VEHICLE LOAN STATUS AND REFUND DIRECTIVE (initial your selection):
____
This loan is satised and proof of payo is attached (e.g., copy of original title and payo letter from the lender).
Issue the refund directly to the contract holder.
____
This vehicle loan is NOT satised; issue the refund directly to the lender identied on the Contract.
Any proceeds which exceed the amount of the outstanding loan balance will be refunded by the lender to the
contract holder.
____
Not applicable - the vehicle was not nanced. The refund will be issued directly to the contract holder.
(initials)
(initials)
(initials)
DEALER INFORMATION
Dealer:
Address:
City: State: Zip:
Phone Number: Dealer Representative:
Reason for Cancellation:
Customer Signature Date
Dealer Representative Date
