Warranty Cancellation Form

Dealership Location

Where did you purchase your vehicle?

Customer Information

First Name

Last Name

Phone

Address

City

State

ZIP

Vehicle Information

Year

Make

Model

VIN

VIN is captured as typed for accuracy.

Odometer (at cancellation)

Enter the exact mileage at time of cancellation.

Contract Details #1

Product Type

Provider

Contract Number

Cancellation Reason

Refund Payee

Lienholder (type exact name)

If a lien existed, enter the lender's exact name.

Documents

Lien Release (PDF/JPG/PNG)

Required if Refund Payee is Customer and a lienholder is listed.

Odometer Proof (dated photo or document)

Upload a dated photo/document showing current mileage.

Submission Instructions

• If Refund Payee is Customer and there was a lien, you must upload the lien release.
• Upload a dated odometer photo or document for mileage verification.
• Ensure provider and reason are selected accurately to avoid delays.

Please Note:

All cancellations will take at least 6–8 weeks to process.

Need Assistance?

Your dedicated Cancellations Liaison, Kevin Doyle, is available to assist you with any questions about your cancellation request.
Email: cancellations@jimnortonauto.com
Phone: (918) 317-7344