Mpp Cancellation Form Details

There are many different types of forms that an individual may need to fill out during their lifetime. One such form is the mpp cancellation form. This form is used to cancel a minimal power of attorney. There are a few steps that need to be taken in order to fill out this form correctly. First, the individual needs to gather all of the information pertaining to the canceled mpp. Next, they need to complete and sign the cancellation form. Finally, they must mail or fax the completed form to their state’s department of revenue. By following these simple steps, the individual can cancel their mpp quickly and easily.

You can find more details regarding the mpp cancellation form by looking through the listing our team put together.

QuestionAnswer
Form NameMpp Cancellation Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesmpp cancellation form, accord cancellation form fillable, protection plan cancellation, cancelled extended warranty mpp

Form Preview Example

Mechanical Protection Plan/ Old United

P.O. Box 634, Shawnee Mission, Ks. 66201‐0634

CANCELLATION REQUEST FORM

All information must be filled out completely and legibly to process this cancellation request

Any information omitted may delay the cancellation process. All cancellations will be processed within 30 days of receipt.

CUSTOMER INFORMATION

Name

______________________________________________________________________________

 

Last

Middle Initial

First

Address

______________________________________________________________________________

City, State & Zip Code

______________________________________________________________________________

Area Code/Phone #

________________________ Email Address _____________________________________________

VEHICLE INFORMATION

 

 

 

Year, Make & Model

Last 6 digits of Vehicle ID # (VIN)

______________________________________________________________________________

______________________________________________________________________________

LIENHOLDER INFORMATION

Is there a lien on the vehicle

Yes 1

No 2

Lienholder Name

_____________________________________ Account #________________________________________

Lienholder Address

____________________________________________________________________________________

1 Cancellation requests received on vehicles that are still secured by a lien must have the lienholders name, address, and account number included on this

cancellation request form. ALL REFUNDS ON VEHICLES THAT ARE STILL SECURED BY A LIEN WILL BE PAID DIRECTLY TO THE LIENHOLDER.

2 Cancellation requests received on vehicles that have had the lien paid off or released must have attached proof of release of lien, copy of clear title or lien release

letter from lienholder. IF NOT INCLUDED, ANY REFUND DUE WILL GO TO THE LIENHOLDER ON FILE.

Flat cancellation may be provided if cancellation is done within 30 days of purchase date and a claim has not been filed.

PLAN(S) TO BE CANCELLED

Please check all boxes that apply (boxes left blank will not be cancelled)

Club Plus

Platinum Plus

Mechanical Service Agreement

Maintenance

Lease Wear

Gap

OnGard

PDR (Paintless Dent Repair)

TireAssure

Credit Insurance

Other:__________________________________________________________________________________________________________________________________

Lojack, Skylink, Skyway, Theft guarantee cancellations can only be processed if the UNIT has not been installed and the cancel request MUST be received from the dealer. Zaktek is non‐cancelable.

REASON FOR CANCELLATION

Vehicle Traded In – (Include odometer statement)

Total Loss – (Need loss paperwork from insurance Company)

Customer Request

Sold Vehicle – (Include odometer statement or bill of sale)

Paid in Full – (include paid in full letter)

Other:__________________________________________________________________________________________________________________________________

Cancellation Mileage _____________________________________Cancellation Date ___________________________________(if other than today’s date see below)

We reserve the right to verify and document date and mileage. For cancellation refunds on clear liens, distribution of cancellation refunds other than described herein must have separate, customer signature‐endorsed instructions. Dealer signature only required on unwind or re‐contracted transactions.

Form sent in by

Customer

Dealer

Lienholder

 

 

Dealer Name

__________________________________________

Customer Name

______________________________________________________

Dealer Signature

__________________________________________

Customer Signature

______________________________________________________

Dealer Signature

__________________________________________

Date Signed

______________________________________________________

FOR DEALER USE ONLY

Vehicle Traded In & Refund to be sent to a participating MPP Dealer – (Include odometer statement) and customer must sign below.

Customer Signature: _____________________________________________________________

I release all rights to my refund amount

Dealer Name ___________________________________ Address ______________________________________________________

White – MPP Copy

Canary – Dealer Copy

Pink – Customer Copy