Cancellation

Town & Country Ford

Experience Our Award Winning Attitude · PellCityFord.com

Product Cancellation Request

Use this form to request cancellation of one or more vehicle service contracts or related products purchased at Town & Country Ford. Fields marked required are required.

1 Dealership Location

Choose the location where you purchased the product. Your request is routed to that store.


2 Customer Information

5-digit ZIP, for example 35022

3 Vehicle Information

Usually 17 characters. Older vehicles may have a shorter VIN.

4 Contract or Product Information

Tell us which product(s) you want to cancel. You can add more than one.

Product 1



5 Reason for Cancellation

Choose the one reason that best applies. *




*Balance will be distributed to the lienholder unless the loan is paid in full.

6 Lienholder and Refund Information
Does the vehicle currently have a lienholder? *


Has the vehicle loan been paid in full? *



7 Required Documents

Accepted formats: PDF, JPG, JPEG, PNG, HEIC, HEIF. Maximum size: 10 MB per file. A clear phone photo works well.

No file selected.

No file selected.

Required for Traded Vehicle or Sold Vehicle to Another Party. Optional for Total Loss and Personal Request.

8 Important Processing Notice

NOTE: If the vehicle still has a lienholder, any cancellation refund will be forwarded to the lienholder. Please complete this form with as much information as possible to expedite your refund. Cancellations will be processed within seven business days. Refunds may take four to six weeks to reach individuals or lienholders.
9 Disclosure and Electronic Signature

By signing and submitting this form, I acknowledge and agree that:

  • The information I provided is true and accurate to the best of my knowledge.
  • I am requesting cancellation of the contract(s) or product(s) identified above.
  • Submitting this request is not confirmation that cancellation is complete.
  • Town & Country Ford may request additional information or documentation.
  • Refund eligibility and amounts are subject to the applicable contract terms.
  • If a lienholder remains on the vehicle, any refund may be sent to the lienholder.
  • My typed full name below is intended to serve as my electronic signature.
  • The submission date and time and my uploaded documents will be recorded as part of this request.

Check the disclosure box above to enable the signature field.

Privacy notice: your electronic signature, submission date and time, and uploaded files are transmitted through Google Apps Script and emailed to the selected dealership for authentication, documentation, and processing.

10 Submit Request

The button becomes available after you accept the disclosure and enter your electronic signature. All required fields are checked when you submit.