Product Support for Susquehanna Automotive

In order to help you, our customers, better understand the products you’ve bought for your vehicle, we’ve created this short informational video. Gap insurance, vehicle service contracts, and cancellation of products are all discussed within the video. In case you opt to terminate any of these products, we've provided a form for you to inform us of your needs. We are committed to ensuring that you are fully aware of the rights you'll be waiving by cancelling these products. To start the process, please view the video below.

The video contains important information that is needed to complete the form. Please watch the entire video.

Required Odometer Statement

Please print and complete the document below, then upload the signed document in the designated area.

Odometer Statement Download

General Information
Please watch the entire video before completing this form, important instructions and an explanation of the rights you are giving up are in the short video.
Buyer First Name*
Buyer Last Name*
Co-Buyer's Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Phone*
Vehicle Information
Miles at Time of Cancellation*
Vehicle Identification Number (VIN#)*
From which dealership did you purchase your vehicle?*
Support Information
Select Product(s) You Wish to Cancel*
- GAP Insurance
- Service Contract (Ext. Warranty)
- Maintenance Plan
*Attention* You will nedd to download and complete the Required Odomenter Statement. This Document is REQUIRED, Cancellations WILL NOT be processed without a completed and Notarized Odometer Statement
Reason for Cancellation?*
- Vehicle has been Sold or Traded - Requires Notarized Odometer, photo of odometer, and Bill of Sale
- Total Loss Or Theft - Requires Notarized Odometer Statement, photo of odometer, and Copy Of Total Loss Report From The Insurance Provider
- Customer Request - Requires Notarized Odometer Statement and photo of odometer
- Refinance - Requires Notarized Odometer Statement, photo of odometer, and Proof Of Payoff On Original Loan
- Using Cancellation Funds Towards A Vehicle Purchase From Susquehanna Ford or Susquehanna Chrysler Dodge Jeep Ram - Copy of New Purchase Agreement
Upload Required Odometer Statement & Other Documents*
Upload Photo of Odometer Miles*
Upload Proof of Payoff
Lien Holder (Type None if no lien holder applies)*
Notes - Please allow up to four weeks for processing. Contact your dealership with questions or concerns
By signing below you are agreeing to the terms of cancellation. Once this form has been completed you are not able to reinstate your policy for any reason.

Proof of odometer is required to ensure the accuracy of your refund, without the required notarized odometer statement your cancellation will not be processed. If you would like to process your cancellation in store, please upload the required documents listed under "Reason for Cancellation". All cancellation proceeds are sent to the lienholder directly. Refunds may be delayed by the lienholder. Please call the lien holder if you have not received cancellation funds in more than 4 weeks.

You must use this website to cancel your contract(s), but you may visit our stores and staff to aid you in the process of cancellation. This software is meant to provide a contactless service and allow our customers to make changes to policies they may have purchased from our Dealerships.
Your Signature*
Select a Date*
Your Comments
This field is for validation purposes and should be left unchanged.

This site is protected by reCAPTCHA

Product Support for Susquehanna Automotive

Required Odometer Statement

General Information

Vehicle Information

Support Information

Inventory

Service

Finance

About

Product Support for Susquehanna Automotive

Required Odometer Statement

General Information

Vehicle Information

Support Information

Menu

Get Directions

Contact Us

Search Vehicles

Search By Keyword:

Search By Filters:

Contact Us

Saved Vehicles

You don't have any saved vehicles!