Policy Cancellation Form

Red McCombs Ford — Policy Cancel Request

Customer / Policy Information

Vehicle Information

Please Email a Copy of Your Paid in Full Letter to adillon@redmac.net and alind@redmac.net

Cancellation Details

Contract to be Canceled

Original Selling Dealership

Cancellation Reason (Please Select Only One)

Issue Refund to (Please Select Only One)

Authorization / Signatures