GAP/Extended Service Cancellation

Fill out the request form below for cancelling GAP or Extended Service plans from Dick Genthe Chevrolet

* = required

Date Of Trade In/Sold/Totaled* If traded, sold to whom?

Which cancelable warranties do you have? Check All That Apply

Ally Premier Protection

GAP

Tire and Wheel

Other

Current Odometer Reading

(Proof of mileage is needed. Please obtain an odometer statement or buyer's order from trading dealership. Upload below.)* VIN -Last 8* Reason For GAP Cancellation* Is Your Loan Paid Off? (Please attach proof of loan pay off, lien release or buyers order from trading dealership) *

Yes No

Was Your Vehicle Totaled By Your Insurance Company? (If yes, attach documents)

Yes No

Customer Number (if available) First Name* Last Name* Untitled Address (Street Address)* City State / Province / Region Postal / Zip Code Country Email* Phone Number* Additional comments

I Have Read The Disclosure

You will be contacted in 3 days, if over that time period please contact us to process your request. If you did not attach the proper documents you may be requested to show proof of the mileage and loan payoff. If you do not wish or cannot retrieve the proper documentation, the refund will be cancelled and sent to the lienholder for review. You may also be subject to sign a cancellation form if the cancellation is a tire and wheel/AUL/ or the requested date of cancel is over 180 days. Please note, GAP and Ally Premier Protection take 7- 10 business days to process and a refund to be mailed out. If you have any questions, please contact Dick Genthe Chevrolet at 866.309.8271.

GAP/Extended Service Cancellation

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