Policy Cancellation Form

First name:

Last name:

Email:

Address (please be sure to include your postal code) :

Phone Number

Contract Number

Hull SN:

Trailer serial #

Motor serial #

Date of purchase

Date of cancellation

Dealer Name:

Dealer Email:

I hereby request that the contract identified herein be canceled. I understand that, by submitting this request for cancellation, I forfeit the rights to the coverage provided by the contract. In the event of a failure of the equipment covered under the contract, I am wholly liable for the cost of the repairs.

Type your name as a signature: