GAP/EXTENDED SERVICE CANCELLATION

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

* Indicates a required field

Date Of Trade In/Sold/Totaled

If traded, sold to whom?

Which cancelable warranties do you have? Check All That

Ally Premier Protection

Tire and Wheel

GAP

Other

Current Odometer Reading

(Proof of mileage is needed. Please obtain an odometer statement or buyer's order from trading dealership. Upload below.)

Reason For GAP Cancellation

VIN -Last 8

Is Your Loan Paid Off? (Please attach proof of loan pay off, lien release or buyers order from trading dealership)

Yes

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

Yes

Customer Number (if available)

First Name

Last Name

Untitled

Address (Street Address)

City

State / Province / Region

MI Postal / Zip Code

Country

Phone Number

Additional comments

Disclosure

I Have Read The Disclosure