Warranty Cancellation

Contact Information

First Name*

Last Name*

Email*

Product Information

Product*

Service Contract Warranty
GAP
Tire and Wheel
VIP Package
Key Replacement

Reason*

Traded (Need Odometer, bill of sale)
Sold/Accident (Need Odometer or total loss documentation)
Do not want the coverage (If financed, check will be mailed to the lienholder)
I wish to use this refund towards my money down on my new vehicle stock. If the refund is lower than quoted, I will pay Countryside Motors/Jidd Enterprises the difference. If there is any overages send my refund to:

Refund Amount

Stock Number

Customer Name

Customer Address

Street Address City State / Province / Region ZIP / Postal Code

Customer Phone Number

I wish to cancel the contract for the product selected here of the vehicle with VIN # with current mileage.

Effective Date*

Vehicle*

VIN Number*

Please upload a picture of your odometer reading

Customer Signature

By entering your name, I am requesting that you please cancel my contract on the above-identified vehicle effective on the cancellation date listed above. I understand that once canceled coverage may not be repurchased or reinstated. I further understand that a cancellation fee may apply after 30 days. Final Submission of this application requires your signature at the dealership as well as millage verification. Please allow 30 days for the refund to be posted to your account; if you paid cash, you will receive a check in the mail.

I am not a Robot

Phone

This field is for validation purposes and should be left unchanged.

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