Product Cancellation

Buyer Information
First Name*
Last Name*
Co-Buyer
First Name
Last Name
Email*
Address
Street Address City State ZIP Code
Home/Mobile Phone*
Work Phone
VEHICLE AND PRODUCT INFO
Miles at time of Cancellation*
Vehicle Identification Number*
Products Being Cancelled*
- Service Contract
- ThreeForOne Protections
- GAP/TLP
- Key Assist
Vehicle Purchased From*
Date Contract Purchased
Reason for Cancellation
- Vehicle has been Sold or Traded - Must Include Odometer Statement
- Total Loss or Theft - Must Include Copy of Total Loss Report with Date of Loss and Mileage
- Customer Request - Must Include Odometer Statement & Proof of Lien Being Satisfied if YOU are Looking to Receive Funds Directly.
- Refi - Must Include Proof of Payoff for Original Loan and Odometer Statement
DOWNLOAD DISCLOSURE STATEMENT
Upload Required Documents Here - Odometer Statement*
Drop files here or
Lien Holder (Type None if Purchased with Cash)*
Complete the information below with a member of our Management team to use Refunds as a down payment
Apply Refunds Towards Down Payment?*
- Yes
- No
Please Enter Dealer Stock Number of New Purchase
Please Enter Amount Being Applied To Purchase
Message

Notes - Please allow four to six weeks for processing. Any Further Questions, Please Call the Dealership Finance Team.
Where did you complete this form?*
- Van Horn Location
- Other Location

Disclaimer
- Yes, I agree to receive text messages from Van Horn to my phone number above. Message frequency varies and may include scheduling appointments, scheduling test drives, and one on one conversations about vehicle maintenance, or occasional promotional and marketing messages. Consent is not a condition of purchase. Message and data rates may apply. Reply “STOP” to unsubscribe at any time. Reply “HELP” for help. We do not share your mobile opt in information with anyone. See our Privacy Policy and our messaging Terms and Conditions for more information about how we handle your data.
Your Email
This field is for validation purposes and should be left unchanged.

This site is protected by reCAPTCHA

Search