Tire Protection - Cancellation Form

Road Hazard Tire & Wheel Florida Cancellation Procedures Step 1 Dealer faxes the following documentation to RpmOne: Completed cancellation form...

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Road Hazard Tire & Wheel CANCELLATION REQUEST FORM

Dealer Name

Contract Holder Name

Contract Holder Address

City/State/ZIP

Vehicle Year/Make/Model

VIN

Contract Purchase Date

Contract Purchase Price

Date of Cancellation

Completed By:

You, the contract holder named above, understand that the Road Hazard Tire & Wheel Protection contract will be cancelled. You must also understand that in the event the above referenced vehicle requires tire or wheel replacement or repair, you the contract holder, will be responsible for payment of all costs associated with the repair or replacement of the tire and wheels of the vehicle.

Contract Holder Signature

Date

Dealer Signature

Date

FAX THIS REQUEST AND A COPY OF THE ORIGINAL CONTRACT TO: Safe-Guard ATTN: CANCELLATION DEPT. FAX: 678-553-1374

Road Hazard Tire & Wheel Florida Cancellation Procedures Step 1 Dealer faxes the following documentation to RpmOne: ● Completed cancellation form ● Copy of customer’s Road Hazard Tire & Wheel Protection contract SafeGuard Fax Information ● FAX #: 678-553-1374 ● ATTN: Cancellations

Step 2 Underwriter calculates agent and dealer refund payments based on: ● Within sixty days of purchase: 100% of amount paid less any claims paid. ● After sixty (60) days: pro-rata refund less 10% cancellation fee (or $50, whichever is less), less any claims paid.

Step 3 Underwriter sends refund payment to RpmOne. Step 4 RpmOne sends dealer refund payment to dealer. Step 5 Dealer refunds customer directly based on: ● Within sixty days of purchase: 100% of amount paid less any claims paid. ● After sixty (60) days: pro-rata refund less 10% cancellation fee (or $50, whichever is less), less any claims paid. Note: Dealer may refund customer at any time in the process. Dealer should call RpmOne Claims department to determine if any claims have been paid.