CANCELLATION QUOTE, REQUEST
AND RELEASE FORM
Guaranteed Asset Protection (GAP) Contract
Quote Date: 4/23/2024 8:55:09 AM
Guaranteed Asset Protection (GAP) Contract means Debt Cancellation Contract, Addendum, Waiver, Certificate or Policy.

Disclaimer
By using the following web pages, you willingly assume all risk in connection with such use. You agree that the Program Administrator will not be held liable or responsible in any way for content, errors or omissions in the following web pages.

Notwithstanding any language to the contrary, nothing in the follow web pages is or is intended to be, an offer, a promise or a contract. The following web pages are for informational purposes only, to assist you in preparing the necessary paperwork to request a cancellation of a GAP Contract, and are not represented to be error free.


Important Notes
    		• This worksheet will help you to prepare a request for cancellation. The process is not complete until you print out all required documents, gather certain additional documents and mail or fax everything to the Program Administrator. The information that you enter using this form will NOT transmit electronically.
    		• PRODUCERS: Cancellations cannot be netted from remittance.


    1. Select Reason for Cancellation and Refund Method
      Reason for Cancellation  
    		• Consumer Request, Unwind, Early Payoff and Repossession. Select the reason that applies in the box above. Inaccurate information will result in an adjustment by the Program Administrator.

    Required Documentation

  • Consumer Request
    1. All pages of this form;
    2. A SIGNED copy of the Request and Release Form; and
    3. A copy of the original (signed) GAP Contract.
  • Unwind (loan never funded or loan funded and vehicle returned)
    1. All pages of this form, except the Request and Release Form;
    2. A copy of the original (signed) GAP Contract; and
    3. A signed statement on Dealer or Lienholder/Assignee company letterhead that the cancellation is due to an unwind.
  • Early Payoff
    1. All pages of this form, except the Request and Release Form;
    2. A copy of the Lienholder/Assignee payoff; and
    3. A copy of the original (signed) GAP Contract.
    4. Colorado, Indiana and Wisconsin customers: Dealer or Lienholder/Assignee must submit a copy of the reserve statement showing the exact loan payoff date.
  • Repossession
    1. All pages of this form, except the Request and Release Form;
    2. A copy of the original (signed) GAP Contract; and
    3. A copy of the repossession letter (from Lienholder/Assignee).
    		•
      Refund Method  
    		• Review the entire GAP Contract to determine the refund method. Select the refund method that applies in the box above. Flat Cancel only available within 30 days of purchase. Wisconsin consumers use Wisconsin. Inaccurate information will result in an adjustment by the Program Administrator.

    2. Enter Contract Information
      GAP Contract Number (Example: ODW12345W)  
      Consumer Name (First and Last)  
      Cost Paid by Consumer for GAP Contract (Example: 500.00)  
      Interest Rate (only required for Actuarial Method)  
      Processing Fee - if applicable (Example: $50.00)  
    		• The Processing Fee ranges from $0 to $50. Review the GAP Contract to determine whether a Processing Fee applies. If a Processing Fee applies, select the fee amount in the box above. Inaccurate information will result in an adjustment by the Program Administrator.

    3. Days In Force Calculation
      Term of Financial Agreement (in Months)  
      Requested Cancellation Date (mm/dd/yy)  
      Contract Effective Date (mm/dd/yy)  



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