customer.swickard.com Open in urlscan Pro
40.114.28.3 Public Scan

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Submitted URL:
http://customer.swickard.com/
Effective URL:
https://customer.swickard.com/
Submission Tags: phish.gg anti.fish automated Search All
Submission: On July 09 via api (July 9th 2023, 4:08:18 pm UTC) from DE — Scanned from DE

Form analysis
6 forms found in the DOM

<form _ngcontent-tky-c37="" novalidate="" class="ng-untouched ng-pristine ng-invalid">
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-3 pe-0">Customer First Name:</label>
    <div _ngcontent-tky-c37="" class="col-sm-4"><span _ngcontent-tky-c37="" class="text-danger ng-star-inserted">*</span><!----><input _ngcontent-tky-c37="" type="text" formcontrolname="firstName" autofocus="" autocomplete="name" maxlength="49"
        class="form-control ng-untouched ng-pristine ng-invalid" style="text-transform: uppercase;"></div><label _ngcontent-tky-c37="" class="col-sm-2 pe-0">Last Name:</label>
    <div _ngcontent-tky-c37="" class="col-sm-3"><span _ngcontent-tky-c37="" class="text-danger ng-star-inserted">*</span><!----><input _ngcontent-tky-c37="" type="text" formcontrolname="lastName" autocomplete="family-name" maxlength="49"
        class="form-control ng-untouched ng-pristine ng-invalid" style="text-transform: uppercase;"></div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-3 pe-0">Email:</label>
    <div _ngcontent-tky-c37="" class="col-sm-4"><span _ngcontent-tky-c37="" class="text-danger ng-star-inserted">*</span><!----><input _ngcontent-tky-c37="" type="text" formcontrolname="emailid"
        pattern="[a-zA-Z0-9._%+-]+@[a-zA-Z0-9.-]+\.[a-zA-Z]{2,5}$" autocomplete="email" maxlength="99" class="form-control ng-untouched ng-pristine ng-invalid"><br _ngcontent-tky-c37=""><!----></div><label _ngcontent-tky-c37=""
      class="col-sm-2 pe-0 mb-1">Phone #:</label>
    <div _ngcontent-tky-c37="" class="col-sm-3"><span _ngcontent-tky-c37="" class="text-danger ng-star-inserted">*</span><!----><input _ngcontent-tky-c37="" type="text" formcontrolname="phone" pattern="[0-9+( )-]{14}$" autocomplete="tel"
        class="form-control ng-untouched ng-pristine ng-invalid"><!----></div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-3 pe-0 mb-0">Preferred method of contact:</label>
    <div _ngcontent-tky-c37="" class="col-sm-4 mb-1">
      <div _ngcontent-tky-c37="" class="radio-item"><input _ngcontent-tky-c37="" type="radio" id="mtconp" name="mtdofcontact" value="p" formcontrolname="mtdofcontact" class="ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37=""
          for="mtconp">Phone</label></div>
      <div _ngcontent-tky-c37="" class="radio-item"><input _ngcontent-tky-c37="" type="radio" id="mtcone" name="mtdofcontact" value="e" formcontrolname="mtdofcontact" class="ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37=""
          for="mtcone">Email</label></div>
    </div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-3 pe-0 mb-0"></label><label _ngcontent-tky-c37="" class="col-sm-8 pe-0 mb-0">Would you like to request expedited processing of this refund?
      Expedited refunds receive quicker processing based on the timeline selected</label></div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-3 pe-0 mb-0">Processing speed:</label>
    <div _ngcontent-tky-c37="" class="col-sm-8 pe-0 mb-0">
      <div _ngcontent-tky-c37="" class="radio-item"><input _ngcontent-tky-c37="" type="radio" id="exp1" name="exportimeframe" value="150" formcontrolname="exportimeframe" class="ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37=""
          for="exp1">$150 (5-7 days)</label></div>
      <div _ngcontent-tky-c37="" class="radio-item"><input _ngcontent-tky-c37="" type="radio" id="exp2" name="exportimeframe" value="79" formcontrolname="exportimeframe" class="ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37=""
          for="exp2">$79 (1-2 weeks)</label></div>
      <div _ngcontent-tky-c37="" class="radio-item"><input _ngcontent-tky-c37="" type="radio" id="exp4" name="exportimeframe" value="49" formcontrolname="exportimeframe" class="ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37=""
          for="exp4">$49 (2-3 weeks)</label></div>
      <div _ngcontent-tky-c37="" class="radio-item"><input _ngcontent-tky-c37="" type="radio" id="exp3" name="exportimeframe" value="0" formcontrolname="exportimeframe" class="ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37=""
          for="exp3">$0 (6-8 weeks)</label></div>
    </div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-3 pe-0">Selling Dealership:</label>
    <div _ngcontent-tky-c37="" class="col-sm-9">
      <div _ngcontent-tky-c37="" class="dropdown"><button _ngcontent-tky-c37="" type="button" id="dropdownMenuButton" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false" class="btn"
          style="width: 101%; height: 100%; position: relative; border-radius: 15px; text-align: inherit; padding-top: 2px; font-size: .7rem; padding-left: 1%;">
          <div _ngcontent-tky-c37="" style="display: flex;"><span _ngcontent-tky-c37="" style="color: #dc3545 !important; font-size: 20px; margin-top: -3px; padding-right: 3px; margin-left: -6px;" class="ng-star-inserted">*</span><!----> SELECT
          </div>
        </button>
        <ul _ngcontent-tky-c37="" aria-labelledby="dropdownMenuButton" class="dropdown-menu" style="overflow: scroll; height: 350px;">
          <li _ngcontent-tky-c37="" class="dropdown-item">SELECT</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> ACURA THOUSAND OAKS (THOUSAND OAKS, CA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> AUDI OF OAKLAND (OAKLAND, CA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> AUDI OF PALO ALTO (PALO ALTO, CA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> BMW LYNNWOOD (LYNNWOOD, WA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> BMW OF EUGENE (EUGENE, OR)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> CHEVROLET THOUSAND OAKS (THOUSAND OAKS, CA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> CROWN TOYOTA (ONTARIO, CA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> EPIC FORD (EVERETT, WA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> GRESHAM TOYOTA (GRESHAM, OR)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> HONDA THOUSAND OAKS (THOUSAND OAKS, CA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> JAGUAR LAND ROVER SAN FRANCISCO (SAN FRANCISCO , CA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> JAGUAR LAND ROVER THOUSAND OAK (THOUSAND OAKS, CA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> LAND ROVER REDWOOD CITY (REDWOOD CITY, CA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> LEXUS OF FREMONT (FREMONT, CA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> LEXUS THOUSAND OAKS (THOUSAND OAKS, CA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> MERCEDES-BENZ OF ANCHORAGE (ANCHORAGE, AK)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> MERCEDES-BENZ OF MARIN (SAN RAFAEL, CA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> MERCEDES-BENZ OF SEATTLE (SEATTLE, WA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> MERCEDES-BENZ OF WILSONVILLE (WILSONVILLE, OR)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> MERCEDES-BENZ THOUSAND OAKS (THOUSAND OAKS, CA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> SWICKARD BUICK GMC OF PALMER (PALMER, AK)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> SWICKARD CHEVROLET (ANCHORAGE, AK)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> SWICKARD HONDA (GLADSTONE, OR)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> SWICKARD MANAGEMENT (WILSONVILLE, OR)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> SWICKARD PORSCHE AUDI VW (ANCHORAGE, AK)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> SWICKARD TOYOTA (EDMONDS, WA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> VOLVO CARS BELLEVUE (BELLEVUE, WA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> VOLVO CARS SEATTLE (SEATTLE, WA)</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> VOLVO CARS SOUTHWEST HOUSTON (HOUSTON, TX)</li><!---->
        </ul>
      </div>
    </div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-3 pe-0">Agreement #/Contract #: </label>
    <div _ngcontent-tky-c37="" class="col-sm-4"><input _ngcontent-tky-c37="" type="text" formcontrolname="contract" maxlength="20" class="form-control ng-untouched ng-pristine ng-valid"></div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-3 pe-0">VIN:</label>
    <div _ngcontent-tky-c37="" class="col-sm-4"><span _ngcontent-tky-c37="" class="text-danger ng-star-inserted">*</span><!----><input _ngcontent-tky-c37="" type="text" formcontrolname="vin" maxlength="17" minlength="17"
        class="form-control ng-untouched ng-pristine ng-invalid" style="text-transform: uppercase;"></div><!---->
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2" style="display: none;"><label _ngcontent-tky-c37="" class="col-sm-3">Vehicle Year:</label>
    <div _ngcontent-tky-c37="" class="col-sm-2 sml">
      <div _ngcontent-tky-c37="" class="dropdown"><button _ngcontent-tky-c37="" type="button" id="dropdownMenuButton" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false" class="btn"
          style="width: 101%; height: 100%; position: relative; border-radius: 15px; text-align: inherit; padding-top: 1px; font-size: .7rem; padding-left: 1%;"><span _ngcontent-tky-c37=""> SELECT </span></button>
        <ul _ngcontent-tky-c37="" aria-labelledby="dropdownMenuButton" class="dropdown-menu" style="overflow: scroll; height: 350px; min-width: 4rem;">
          <li _ngcontent-tky-c37="" class="dropdown-item deactive">SELECT</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2023</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2022</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2021</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2020</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2019</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2018</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2017</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2016</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2015</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2014</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2013</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2012</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2011</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2010</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2009</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2008</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2007</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2006</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2005</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2004</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2003</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2002</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2001</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 2000</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1999</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1998</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1997</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1996</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1995</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1994</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1993</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1992</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1991</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1990</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1989</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1988</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1987</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1986</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1985</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1984</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1983</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1982</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> 1981</li><!---->
        </ul>
      </div>
    </div><label _ngcontent-tky-c37="" class="col-sm-1 mb-1">Make:</label>
    <div _ngcontent-tky-c37="" class="col-sm-2 deactive">
      <div _ngcontent-tky-c37="" class="dropdown"><button _ngcontent-tky-c37="" type="button" id="dropdownMenuButton" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false" class="btn"
          style="width: 101%; height: 100%; position: relative; border-radius: 15px; text-align: inherit; padding-top: 1px; font-size: .7rem; padding-left: 1%; overflow: hidden;"><span _ngcontent-tky-c37=""> SELECT </span></button>
        <ul _ngcontent-tky-c37="" aria-labelledby="dropdownMenuButton" class="dropdown-menu" style="overflow: scroll; height: 350px; min-width: 7rem;">
          <li _ngcontent-tky-c37="" class="dropdown-item deactive">SELECT</li><!---->
        </ul>
      </div>
    </div><label _ngcontent-tky-c37="" class="col-sm-1 mb-1">Model:</label>
    <div _ngcontent-tky-c37="" class="col-sm-3 sml deactive">
      <div _ngcontent-tky-c37="" class="dropdown"><button _ngcontent-tky-c37="" type="button" id="dropdownMenuButton" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false" class="btn"
          style="width: 101%; height: 100%; position: relative; border-radius: 15px; text-align: inherit; padding-top: 1px; font-size: .7rem; padding-left: 1%; overflow: hidden;"><span _ngcontent-tky-c37=""> SELECT </span></button>
        <ul _ngcontent-tky-c37="" aria-labelledby="dropdownMenuButton" class="dropdown-menu mddrpdwn">
          <li _ngcontent-tky-c37="" class="dropdown-item deactive">SELECT</li><!---->
        </ul>
      </div>
    </div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-3 pe-0">Date of Contract:</label>
    <div _ngcontent-tky-c37="" class="col-sm-4"><input _ngcontent-tky-c37="" type="date" name="contract" formcontrolname="dateOfContract" autocomplete="bday" class="datepicker ng-untouched ng-pristine ng-valid"></div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-3 pe-0">Date of Cancellation:</label>
    <div _ngcontent-tky-c37="" class="col-sm-4 sml"><input _ngcontent-tky-c37="" type="date" name="cancellation" formcontrolname="dateOfCancellation" autocomplete="bday" min="2023-04-09" class="datepicker ng-untouched ng-pristine ng-valid"></div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-3 pe-0">Mileage at time of cancellation:</label>
    <div _ngcontent-tky-c37="" class="col-sm-4"><input _ngcontent-tky-c37="" type="text" maxlength="6" formcontrolname="mileage" class="form-control ng-untouched ng-pristine ng-valid"></div>
  </div>
</form>

<form _ngcontent-tky-c37="" novalidate="" class="ng-untouched ng-pristine ng-valid">
  <div _ngcontent-tky-c37="" class="row align-items-center">
    <div _ngcontent-tky-c37="" class="col-lg-6">
      <h6 _ngcontent-tky-c37="">Reason for cancellation</h6>
    </div>
    <div _ngcontent-tky-c37="" class="col-lg-6"><input _ngcontent-tky-c37="" type="file" formcontrolname="upload" style="display: none;"
        class="ng-untouched ng-pristine ng-valid"><a _ngcontent-tky-c37="" href="javascript:void(0);" class="ms-3"><img _ngcontent-tky-c37="" src="assets/images/upload_icon.png" style="cursor: pointer;"><span _ngcontent-tky-c37="" class="text-danger ng-star-inserted" style="margin-top: -9px; margin-left: 0px;">*</span><!----> &nbsp; <span _ngcontent-tky-c37="" style="cursor: pointer;">upload document</span></a><br
        _ngcontent-tky-c37=""><span _ngcontent-tky-c37="" style="padding-left: 15%;" class="ng-star-inserted"> </span><!----></div>
  </div>
  <div _ngcontent-tky-c37=""><label _ngcontent-tky-c37="" for="symbols"></label><span _ngcontent-tky-c37="">Select why you are canceling the contract and then upload the required document by selecting ‘Upload document’</span></div>
  <div _ngcontent-tky-c37=""><input _ngcontent-tky-c37="" type="checkbox" id="symbols" formcontrolname="customerRequest" class="custom-check-box ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37="" for="symbols"></label><span
      _ngcontent-tky-c37="">No longer want product <i _ngcontent-tky-c37="">(secure odometer reading required)</i></span></div>
  <div _ngcontent-tky-c37=""><input _ngcontent-tky-c37="" type="checkbox" id="symbolssd" formcontrolname="SalesDeal" class="custom-check-box ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37="" for="symbolssd"></label><span
      _ngcontent-tky-c37="">Sales deal voided <i _ngcontent-tky-c37="">(secure odometer reading required)</i></span></div>
  <div _ngcontent-tky-c37=""><input _ngcontent-tky-c37="" type="checkbox" id="symbols1" formcontrolname="vehicleSold" class="custom-check-box ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37="" for="symbols1"></label><span
      _ngcontent-tky-c37="">Vehicle Sold / Traded <i _ngcontent-tky-c37="">(trade-in / sale documentation required)</i></span></div>
  <div _ngcontent-tky-c37=""><input _ngcontent-tky-c37="" type="checkbox" id="symbols2" formcontrolname="repossession" class="custom-check-box ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37="" for="symbols2"></label><span
      _ngcontent-tky-c37=""> Repossession <i _ngcontent-tky-c37=""> (supporting documentation required)</i></span></div>
  <div _ngcontent-tky-c37=""><input _ngcontent-tky-c37="" type="checkbox" id="symbols3" formcontrolname="satisfiedLien" class="custom-check-box ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37="" for="symbols3"></label><span
      _ngcontent-tky-c37=""> Satisfied Lien/Vehicle Paid Off <i _ngcontent-tky-c37=""> (proof of payoff documentation required)</i></span></div>
  <div _ngcontent-tky-c37=""><input _ngcontent-tky-c37="" type="checkbox" id="symbols4" formcontrolname="totalLossofVehicle" class="custom-check-box ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37="" for="symbols4"></label><span
      _ngcontent-tky-c37=""> Total Loss of Vehicle <i _ngcontent-tky-c37=""> (total loss documentation required)</i></span></div>
  <div _ngcontent-tky-c37="" class="row">
    <div _ngcontent-tky-c37="" class="col-sm-6"><input _ngcontent-tky-c37="" type="checkbox" id="symbols5" formcontrolname="other" class="custom-check-box ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37="" for="symbols5"></label><span
        _ngcontent-tky-c37=""> Other <i _ngcontent-tky-c37=""> (please specify reason) </i></span></div>
    <div _ngcontent-tky-c37="" class="col-sm-6 deactive"><input _ngcontent-tky-c37="" id="otherText" type="text" formcontrolname="otheretext" maxlength="499" class="form-control ng-untouched ng-pristine ng-valid" readonly=""></div>
  </div>
  <div _ngcontent-tky-c37=""><input _ngcontent-tky-c37="" type="checkbox" id="symbols13" formcontrolname="dealercancellation" class="custom-check-box ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37="" for="symbols13"></label><span
      _ngcontent-tky-c37=""> Dealer Cancellation </span></div>
</form>

<form _ngcontent-tky-c37="" novalidate="" class="ng-untouched ng-pristine ng-valid">
  <div _ngcontent-tky-c37="" class="row align-items-center mb-3">
    <div _ngcontent-tky-c37="" class="col-lg-4" style="white-space: nowrap;">
      <h6 _ngcontent-tky-c37="" style="margin-bottom: 0;">Type of contract</h6>
    </div>
    <div _ngcontent-tky-c37="" class="col-lg-8 col-12">
      <div _ngcontent-tky-c37="" class="row align-items-center">
        <div _ngcontent-tky-c37="" class="col-4 contract"></div>
        <div _ngcontent-tky-c37="" class="col-lg-8 col-6 px-0"><input _ngcontent-tky-c37="" type="file" formcontrolname="uploadContract" style="display: none;"
            class="ng-untouched ng-pristine ng-valid"><a _ngcontent-tky-c37="" href="javascript:void(0);" class="ms-3"><img _ngcontent-tky-c37="" src="assets/images/upload_icon.png"> &nbsp; <span _ngcontent-tky-c37="" class="upld_cnt">upload contract (optional)</span></a><br
            _ngcontent-tky-c37=""><!----></div>
      </div>
    </div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-3">
    <div _ngcontent-tky-c37="" class="col-lg-12"><span _ngcontent-tky-c37="">Please select the company that is displayed on your contract. If the contract does not state “Principal Warranty Corp” then it is most likely a manufacturer contract.
      </span></div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center">
    <div _ngcontent-tky-c37="" class="col-lg-6 col-xxl-4">
      <div _ngcontent-tky-c37="" class="row align-items-center">
        <div _ngcontent-tky-c37="" class="col-8 col-xxl-6 contract">
          <div _ngcontent-tky-c37="" class="dropdown"><button _ngcontent-tky-c37="" type="button" id="dropdownMenuButton" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false" class="btn"
              style="width: 101%; height: 100%; position: relative; border-radius: 15px; text-align: inherit; padding-top: 1px; font-size: .7rem; padding-left: 0%;"><span _ngcontent-tky-c37="">SELECT </span></button>
            <ul _ngcontent-tky-c37="" aria-labelledby="dropdownMenuButton" class="dropdown-menu" style="width: auto;">
              <li _ngcontent-tky-c37="" class="dropdown-item">SELECT </li>
              <li _ngcontent-tky-c37="" class="dropdown-item">Manufacturer </li>
              <li _ngcontent-tky-c37="" class="dropdown-item">Principal Warranty Corp</li>
            </ul>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div _ngcontent-tky-c37="" class="row mt-3">
    <div _ngcontent-tky-c37="" class="col-lg-6"><input _ngcontent-tky-c37="" type="checkbox" id="symbols6" formcontrolname="vehicleServiceContract" class="custom-check-box ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37=""
        for="symbols6"></label><span _ngcontent-tky-c37="">Vehicle Service Contract</span></div>
    <div _ngcontent-tky-c37="" class="col-lg-6"><input _ngcontent-tky-c37="" type="checkbox" id="symbols7" formcontrolname="gap" class="custom-check-box ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37="" for="symbols7"></label><span
        _ngcontent-tky-c37="">GAP</span></div>
    <div _ngcontent-tky-c37="" class="col-lg-6"><input _ngcontent-tky-c37="" type="checkbox" id="symbols8" formcontrolname="ancillary" class="custom-check-box ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37=""
        for="symbols8"></label><span _ngcontent-tky-c37="">Ancillary <i _ngcontent-tky-c37="">(specify product type)</i></span></div>
    <div _ngcontent-tky-c37="" class="col-lg-6 deactive"><input _ngcontent-tky-c37="" type="text" formcontrolname="ancillaryType" maxlength="99" class="form-control ng-untouched ng-pristine ng-valid" readonly=""></div>
  </div>
</form>

<form _ngcontent-tky-c37="" novalidate="" class="ng-untouched ng-pristine ng-valid">
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-2 pe-0">Contract Owner:</label>
    <div _ngcontent-tky-c37="" class="col-sm-10 active"><input _ngcontent-tky-c37="" type="text" formcontrolname="contractOwner" autocomplete="name" maxlength="499" class="form-control ng-untouched ng-pristine ng-valid"></div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-2 pe-0">Address:</label>
    <div _ngcontent-tky-c37="" class="col-sm-10 active"><input _ngcontent-tky-c37="" type="text" formcontrolname="address" maxlength="499" class="form-control ng-untouched ng-pristine ng-valid"></div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-2 pe-0 mb-1">City:</label>
    <div _ngcontent-tky-c37="" class="col-sm-3 active"><input _ngcontent-tky-c37="" type="text" formcontrolname="city" maxlength="49" class="form-control ng-untouched ng-pristine ng-valid"></div><label _ngcontent-tky-c37="" class="col-sm-1 mb-1"
      style="padding-left: 15px;">State:</label>
    <div _ngcontent-tky-c37="" class="col-sm-3 active" style="padding-left: 15px;">
      <div _ngcontent-tky-c37="" class="dropdown" style="padding-left: 3px;"><button _ngcontent-tky-c37="" type="button" id="dropdownMenuButton" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false" class="btn"
          style="width: 101%; height: 100%; position: relative; border-radius: 15px; text-align: inherit; padding-top: 1px; font-size: .7rem; padding-left: 1%; overflow: hidden;"> SELECT </button>
        <ul _ngcontent-tky-c37="" aria-labelledby="dropdownMenuButton" class="dropdown-menu" style="overflow: scroll; height: 350px; width: auto;">
          <li _ngcontent-tky-c37="" class="dropdown-item deactive">SELECT</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Alabama</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Alaska</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Arizona</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Arkansas</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> California</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Colorado</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Connecticut</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Delaware</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> District of Columbia</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Florida</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Georgia</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Hawaii</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Idaho</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Illinois</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Indiana</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Iowa</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Kansas</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Kentucky</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Louisiana</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Maine</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Maryland</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Massachusetts</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Michigan</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Minnesota</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Mississippi</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Missouri</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Montana</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Nebraska</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Nevada</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> New Hampshire</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> New Jersey</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> New Mexico</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> New York</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> North Carolina</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> North Dakota</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Ohio</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Oklahoma</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Oregon</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Pennsylvania</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Rhode Island</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> South Carolina</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> South Dakota</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Tennessee</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Texas</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Utah</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Vermont</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Virginia</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Washington</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> West Virginia</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Wisconsin</li>
          <li _ngcontent-tky-c37="" class="dropdown-item ng-star-inserted"> Wyoming</li><!---->
        </ul>
      </div>
    </div><label _ngcontent-tky-c37="" class="col-sm-1 mb-1">Zip:</label>
    <div _ngcontent-tky-c37="" class="col-sm-2 active"><input _ngcontent-tky-c37="" type="text" formcontrolname="zip" maxlength="5" autocomplete="postal-code" class="form-control ng-untouched ng-pristine ng-valid"></div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2">
    <div _ngcontent-tky-c37="" class="col-10"><span _ngcontent-tky-c37="" style="padding-right: 20px;">Do you still have an outstanding loan or lease?</span>
      <div _ngcontent-tky-c37="" class="radio-item active"><input _ngcontent-tky-c37="" type="radio" id="ritema" name="outstandingLoan" value="Y" formcontrolname="outstandingLoan" class="ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37=""
          for="ritema">Yes</label></div>
      <div _ngcontent-tky-c37="" class="radio-item active"><input _ngcontent-tky-c37="" type="radio" id="ritemb" name="outstandingLoan" value="N" formcontrolname="outstandingLoan" class="ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37=""
          for="ritemb">No</label></div>
    </div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><!----></div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2" style="display: none;"><!----></div><!---->
  <div _ngcontent-tky-c37="" style="display: none;" class="ng-star-inserted">
    <p _ngcontent-tky-c37="" class="ng-star-inserted">Request Electronic Delivery (ACH) &nbsp; <span _ngcontent-tky-c37="" class="deactive"><input _ngcontent-tky-c37="" type="checkbox" id="symbols9" formcontrolname="ach"
          class="custom-check-box ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37="" for="symbols9"></label></span></p><!---->
  </div><!---->
  <div _ngcontent-tky-c37="" style="display: none;" class="ng-star-inserted"><!----></div><!---->
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><!---->
    <div _ngcontent-tky-c37="" class="col-8"><input _ngcontent-tky-c37="" type="checkbox" id="symbols11" checked="" formcontrolname="agreeCancellationTerms" class="custom-check-box ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37=""
        for="symbols11"></label><span _ngcontent-tky-c37="" style="font-weight: bold; font-family: Gotham Bold;">I agree to the Terms of Cancellation</span></div>
  </div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2"><label _ngcontent-tky-c37="" class="col-sm-3 pe-0" style="width: 60%; font-weight: bold; font-family: Gotham Bold;">Customer&nbsp;Signature:</label><span _ngcontent-tky-c37=""
      class="col-sm-2 col-2 px-0 pe-0 mb-1" style="padding-left: 3px;">&nbsp;<input _ngcontent-tky-c37="" type="checkbox" formcontrolname="customerSignchk" class="ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37=""
        for="symbols"></label></span></div>
  <div _ngcontent-tky-c37="" class="row align-items-center mb-2">
    <div _ngcontent-tky-c37="" class="col-sm-11"><span _ngcontent-tky-c37="">By selecting the checkbox, I certify that this is my digital signature and I agree to the <span _ngcontent-tky-c37="" data-bs-toggle="modal" data-bs-target="#contModal"
          style="color: blue; cursor: pointer;">terms and conditions</span> of the service cancellation</span></div>
  </div>
</form>

<form _ngcontent-tky-c37="" novalidate="" class="ng-untouched ng-pristine ng-valid"><input _ngcontent-tky-c37="" type="checkbox" id="symbols" formcontrolname="acknowledge" class="ng-untouched ng-pristine ng-valid"><label _ngcontent-tky-c37=""
    for="symbols"></label> &nbsp; <span _ngcontent-tky-c37="" style="font-family: Gotham Bold; font-size: 0.9rem; color: black;">By selecting the checkbox, I acknowledge that:</span>
  <ol _ngcontent-tky-c37="" style="font-family: Gotham Book Regular; color: black;">
    <li _ngcontent-tky-c37="">The refund process can take up to 45 days, from the time your completed cancellation paperwork is received. </li>
    <li _ngcontent-tky-c37="">If any information is incorrect or missing, I agree to be contacted at the preferred method above. No refund will be issued until I have provided complete and correct documents and information. </li>
    <li _ngcontent-tky-c37="">The refund will be prorated and is paid to the lien holder if applicable and not to me</li>
    <li _ngcontent-tky-c37="">I will no longer have this service product after I submit the cancellation</li>
  </ol>
</form>

<form _ngcontent-tky-c37="" novalidate="" class="ng-untouched ng-pristine ng-invalid">
  <div _ngcontent-tky-c37="" class="border border-dark p-4">
    <h5 _ngcontent-tky-c37="">Credit/Debit Card</h5>
    <div _ngcontent-tky-c37="" class="col-12">
      <div _ngcontent-tky-c37="" class="row mb-2 d-flex align-items-center">
        <div _ngcontent-tky-c37="" class="col-3 pe-0">
          <h6 _ngcontent-tky-c37="">Accepted Cards:</h6>
        </div>
        <div _ngcontent-tky-c37="" class="col-5 ps-0"><i _ngcontent-tky-c37="" class="fa fa-cc-visa" style="color: navy; font-size: xx-large;"></i>&nbsp;
          <i _ngcontent-tky-c37="" class="fa fa-cc-amex" style="color: blue; font-size: xx-large;"></i>&nbsp; <i _ngcontent-tky-c37="" class="fa fa-cc-mastercard" style="color: red; font-size: xx-large;"></i>&nbsp;
          <i _ngcontent-tky-c37="" class="fa fa-cc-discover" style="color: orange; font-size: xx-large;"></i>&nbsp; </div>
      </div>
      <div _ngcontent-tky-c37="" class="row mb-2 d-flex align-items-center">
        <div _ngcontent-tky-c37="" class="col-3 pe-0">
          <h6 _ngcontent-tky-c37="">Holder Name:</h6>
        </div>
        <div _ngcontent-tky-c37="" class="col-5 ps-0"><span _ngcontent-tky-c37="" style="color: red; position: absolute; font-size: 1.5rem;" class="ng-star-inserted">*</span><!----><input _ngcontent-tky-c37="" type="text" formcontrolname="name"
            maxlength="50" placeholder="xxxxxxxxx" class="form-control ng-untouched ng-pristine ng-invalid"></div><!---->
      </div>
      <div _ngcontent-tky-c37="" class="row mb-2 d-flex align-items-center">
        <div _ngcontent-tky-c37="" class="col-3 pe-0">
          <h6 _ngcontent-tky-c37="">Card Number:</h6>
        </div>
        <div _ngcontent-tky-c37="" class="col-5 ps-0"><span _ngcontent-tky-c37="" style="color: red; position: absolute; font-size: 1.5rem;" class="ng-star-inserted">*</span><!----><input _ngcontent-tky-c37="" type="text" formcontrolname="number"
            placeholder="  xxxx-xxxx-xxxx-xxxx" class="form-control ng-untouched ng-pristine ng-invalid"></div>
        <div _ngcontent-tky-c37="" class="col-4 ps-0"><!----><!----></div>
      </div>
      <div _ngcontent-tky-c37="" class="row mb-2 d-flex align-items-center">
        <div _ngcontent-tky-c37="" class="col-3 pe-0">
          <h6 _ngcontent-tky-c37="">Exp Date:</h6>
        </div>
        <div _ngcontent-tky-c37="" class="col-5 ps-0 d-flex">
          <div _ngcontent-tky-c37="" class="dd1">
            <div _ngcontent-tky-c37="" class="dropdown"><span _ngcontent-tky-c37="" style="color: red; position: absolute; font-size: 1.5rem;"
                class="ng-star-inserted">*</span><!----><a _ngcontent-tky-c37="" href="#month" role="button" id="dropdownMenuLink" data-bs-toggle="dropdown" aria-expanded="false" class="btn btn-secondary dropdown-toggle"> MM </a>
              <ul _ngcontent-tky-c37="" id="month" aria-labelledby="dropdownMenuLink" class="dropdown-menu" style="overflow-y: scroll; height: 150px;">
                <li _ngcontent-tky-c37=""><a _ngcontent-tky-c37="" class="dropdown-item">01</a></li>
                <li _ngcontent-tky-c37=""><a _ngcontent-tky-c37="" class="dropdown-item">02</a></li>
                <li _ngcontent-tky-c37=""><a _ngcontent-tky-c37="" class="dropdown-item">03</a></li>
                <li _ngcontent-tky-c37=""><a _ngcontent-tky-c37="" class="dropdown-item">04</a></li>
                <li _ngcontent-tky-c37=""><a _ngcontent-tky-c37="" class="dropdown-item">05</a></li>
                <li _ngcontent-tky-c37=""><a _ngcontent-tky-c37="" class="dropdown-item">06</a></li>
                <li _ngcontent-tky-c37=""><a _ngcontent-tky-c37="" class="dropdown-item">07</a></li>
                <li _ngcontent-tky-c37=""><a _ngcontent-tky-c37="" class="dropdown-item">08</a></li>
                <li _ngcontent-tky-c37=""><a _ngcontent-tky-c37="" class="dropdown-item">09</a></li>
                <li _ngcontent-tky-c37=""><a _ngcontent-tky-c37="" class="dropdown-item">10</a></li>
                <li _ngcontent-tky-c37=""><a _ngcontent-tky-c37="" class="dropdown-item">11</a></li>
                <li _ngcontent-tky-c37=""><a _ngcontent-tky-c37="" class="dropdown-item">12</a></li>
              </ul>
            </div>
          </div>
          <div _ngcontent-tky-c37="" class="dd2">
            <div _ngcontent-tky-c37="" class="dropdown ms-1"><span _ngcontent-tky-c37="" style="color: red; position: absolute; font-size: 1.5rem;"
                class="ng-star-inserted">*</span><!----><a _ngcontent-tky-c37="" href="#" role="button" id="dropdownMenuLink" data-bs-toggle="dropdown" aria-expanded="false" class="btn btn-secondary dropdown-toggle"> YYYY </a>
              <ul _ngcontent-tky-c37="" aria-labelledby="dropdownMenuLink" class="dropdown-menu" style="overflow-y: scroll; height: 150px;">
                <li _ngcontent-tky-c37="" class="ng-star-inserted"><a _ngcontent-tky-c37="" class="dropdown-item">2023</a></li>
                <li _ngcontent-tky-c37="" class="ng-star-inserted"><a _ngcontent-tky-c37="" class="dropdown-item">2024</a></li>
                <li _ngcontent-tky-c37="" class="ng-star-inserted"><a _ngcontent-tky-c37="" class="dropdown-item">2025</a></li>
                <li _ngcontent-tky-c37="" class="ng-star-inserted"><a _ngcontent-tky-c37="" class="dropdown-item">2026</a></li>
                <li _ngcontent-tky-c37="" class="ng-star-inserted"><a _ngcontent-tky-c37="" class="dropdown-item">2027</a></li>
                <li _ngcontent-tky-c37="" class="ng-star-inserted"><a _ngcontent-tky-c37="" class="dropdown-item">2028</a></li><!---->
              </ul>
            </div>
          </div>
        </div><!---->
      </div>
      <div _ngcontent-tky-c37="" class="row mb-2 d-flex align-items-center">
        <div _ngcontent-tky-c37="" class="col-3 pe-0">
          <h6 _ngcontent-tky-c37="">CVV:</h6>
        </div>
        <div _ngcontent-tky-c37="" class="col-5 ps-0 cvv"><span _ngcontent-tky-c37="" style="color: red; position: absolute; font-size: 1.5rem;" class="ng-star-inserted">*</span><!----><input _ngcontent-tky-c37="" type="password" id="paycvv"
            maxlength="3" minlength="3" placeholder=" xxx" formcontrolname="cvvnumber" class="form-control ng-untouched ng-pristine ng-invalid"></div>
        <div _ngcontent-tky-c37="" class="col-4 ps-0"><!----><!----></div>
      </div>
    </div>
    <div _ngcontent-tky-c37="" class="d-flex justify-content-center mt-5"><button _ngcontent-tky-c37="" type="button" class="btn btn-primary pay-btn">Pay</button></div>
  </div>
</form>

Text Content

CANCELLATION REQUEST FORM
Check status of your Request
Note: Any refund amount will be paid to the lienholder (if applicable) and
applied by the lienholder in accordance with the terms and conditions of any
financial arrangement you have with the lienholder. If applicable, canceling
service products will not lower your payment.

VEHICLE DETAILS

Customer First Name:
*
Last Name:
*
Email:
*

Phone #:
*
Preferred method of contact:
Phone
Email
Would you like to request expedited processing of this refund? Expedited refunds
receive quicker processing based on the timeline selected
Processing speed:
$150 (5-7 days)
$79 (1-2 weeks)
$49 (2-3 weeks)
$0 (6-8 weeks)
Selling Dealership:
* SELECT
 * SELECT
 * ACURA THOUSAND OAKS (THOUSAND OAKS, CA)
 * AUDI OF OAKLAND (OAKLAND, CA)
 * AUDI OF PALO ALTO (PALO ALTO, CA)
 * BMW LYNNWOOD (LYNNWOOD, WA)
 * BMW OF EUGENE (EUGENE, OR)
 * CHEVROLET THOUSAND OAKS (THOUSAND OAKS, CA)
 * CROWN TOYOTA (ONTARIO, CA)
 * EPIC FORD (EVERETT, WA)
 * GRESHAM TOYOTA (GRESHAM, OR)
 * HONDA THOUSAND OAKS (THOUSAND OAKS, CA)
 * JAGUAR LAND ROVER SAN FRANCISCO (SAN FRANCISCO , CA)
 * JAGUAR LAND ROVER THOUSAND OAK (THOUSAND OAKS, CA)
 * LAND ROVER REDWOOD CITY (REDWOOD CITY, CA)
 * LEXUS OF FREMONT (FREMONT, CA)
 * LEXUS THOUSAND OAKS (THOUSAND OAKS, CA)
 * MERCEDES-BENZ OF ANCHORAGE (ANCHORAGE, AK)
 * MERCEDES-BENZ OF MARIN (SAN RAFAEL, CA)
 * MERCEDES-BENZ OF SEATTLE (SEATTLE, WA)
 * MERCEDES-BENZ OF WILSONVILLE (WILSONVILLE, OR)
 * MERCEDES-BENZ THOUSAND OAKS (THOUSAND OAKS, CA)
 * SWICKARD BUICK GMC OF PALMER (PALMER, AK)
 * SWICKARD CHEVROLET (ANCHORAGE, AK)
 * SWICKARD HONDA (GLADSTONE, OR)
 * SWICKARD MANAGEMENT (WILSONVILLE, OR)
 * SWICKARD PORSCHE AUDI VW (ANCHORAGE, AK)
 * SWICKARD TOYOTA (EDMONDS, WA)
 * VOLVO CARS BELLEVUE (BELLEVUE, WA)
 * VOLVO CARS SEATTLE (SEATTLE, WA)
 * VOLVO CARS SOUTHWEST HOUSTON (HOUSTON, TX)
   

Agreement #/Contract #:

VIN:
*
Vehicle Year:
SELECT
 * SELECT
 * 2023
 * 2022
 * 2021
 * 2020
 * 2019
 * 2018
 * 2017
 * 2016
 * 2015
 * 2014
 * 2013
 * 2012
 * 2011
 * 2010
 * 2009
 * 2008
 * 2007
 * 2006
 * 2005
 * 2004
 * 2003
 * 2002
 * 2001
 * 2000
 * 1999
 * 1998
 * 1997
 * 1996
 * 1995
 * 1994
 * 1993
 * 1992
 * 1991
 * 1990
 * 1989
 * 1988
 * 1987
 * 1986
 * 1985
 * 1984
 * 1983
 * 1982
 * 1981
   

Make:
SELECT
 * SELECT
   

Model:
SELECT
 * SELECT
   

Date of Contract:

Date of Cancellation:

Mileage at time of cancellation:


REASON FOR CANCELLATION

*   upload document

Select why you are canceling the contract and then upload the required document
by selecting ‘Upload document’
No longer want product (secure odometer reading required)
Sales deal voided (secure odometer reading required)
Vehicle Sold / Traded (trade-in / sale documentation required)
Repossession (supporting documentation required)
Satisfied Lien/Vehicle Paid Off (proof of payoff documentation required)
Total Loss of Vehicle (total loss documentation required)
Other (please specify reason)

Dealer Cancellation

TYPE OF CONTRACT

  upload contract (optional)

Please select the company that is displayed on your contract. If the contract
does not state “Principal Warranty Corp” then it is most likely a manufacturer
contract.
SELECT
 * SELECT
 * Manufacturer
 * Principal Warranty Corp

Vehicle Service Contract
GAP
Ancillary (specify product type)


CANCELLATION REFUND DETAILS

Please make refund check payable to: (Lien satisfied letter from the lienholder
or copy of the title is required as proof of payoff)

Contract Owner:

Address:

City:

State:
SELECT
 * SELECT
 * Alabama
 * Alaska
 * Arizona
 * Arkansas
 * California
 * Colorado
 * Connecticut
 * Delaware
 * District of Columbia
 * Florida
 * Georgia
 * Hawaii
 * Idaho
 * Illinois
 * Indiana
 * Iowa
 * Kansas
 * Kentucky
 * Louisiana
 * Maine
 * Maryland
 * Massachusetts
 * Michigan
 * Minnesota
 * Mississippi
 * Missouri
 * Montana
 * Nebraska
 * Nevada
 * New Hampshire
 * New Jersey
 * New Mexico
 * New York
 * North Carolina
 * North Dakota
 * Ohio
 * Oklahoma
 * Oregon
 * Pennsylvania
 * Rhode Island
 * South Carolina
 * South Dakota
 * Tennessee
 * Texas
 * Utah
 * Vermont
 * Virginia
 * Washington
 * West Virginia
 * Wisconsin
 * Wyoming
   

Zip:

Do you still have an outstanding loan or lease?
Yes
No



Request Electronic Delivery (ACH)  


I agree to the Terms of Cancellation
Customer Signature: 
By selecting the checkbox, I certify that this is my digital signature and I
agree to the terms and conditions of the service cancellation
  By selecting the checkbox, I acknowledge that:
 1. The refund process can take up to 45 days, from the time your completed
    cancellation paperwork is received.
 2. If any information is incorrect or missing, I agree to be contacted at the
    preferred method above. No refund will be issued until I have provided
    complete and correct documents and information.
 3. The refund will be prorated and is paid to the lien holder if applicable and
    not to me
 4. I will no longer have this service product after I submit the cancellation



Submit
Please Enter all information


Upload document for the cancellation reason
Ok

Note: Any refund amount will be paid to the lienholder (if applicable) and
applied by the lienholder in accordance with the terms and conditions of any
financial arrangement you have with the lienholder. If applicable, canceling
service products will not lower your payment.
If you have any questions please email .
Would you still like to submit your request?
Yes  No
Ok 
Your payment of $ for Ref#: was processed successfully.
Card: **********
Ok 

Terms and Conditionsx
Terms and Conditions for Cancellation of Product
By submitting this Cancellation Request Form (“CRF”) to Swickard Auto Group, its
affiliates, or its subsidiaries (the “Company”), you acknowledge and agree to
the following:

Original Cancellation Terms. You agree and acknowledge that you (i) reviewed
your original contract, (ii) read and understood all contents of the original
contract including all provisions regarding cancellation, (iii) understand all
obligations, terms, and conditions of cancellation and the ramifications of
submitting this CRF, and (iv) will abide by and follow all terms and
requirements outlined in the original contract regarding the cancellation of the
product which you are intending to cancel by submitting this CRF. In the event
of any conflict between these terms and conditions, the terms and conditions of
your original contract control and supersede anything to the contrary herein.
Please refer to your original contract for any state specific provisions which
supersede the terms herein.

Process. You understand and agree that Company is merely a transmitter of your
cancellation request and that Company does not have any liability or
responsibility for the completion of your cancellation. Company offers this CRF
process as a matter of convenience and hereby disclaims and denies any recourse
that you may have to Company for any failure or delay impacting your
cancellation whatsoever. Your recourse is solely to the provider of your
original contract. You understand and agree that the original contract holder
may deduct a fee from the cancellation refund, if any, owed to you or your
lienholder and that if the fee is greater than the refund amount, you will not
receive any refund. You understand and agree that once cancelled, you may not be
able to reinstate or transfer your original contract.

You understand that the cancellation process may take, on average, 45 days to
complete, and you agree and understand that submission of the cancellation will
result in cancellation of the service product from the time of submission, not
the time of completion of the cancellation process.You agree and understand that
you will no longer have access to the service product once the CRF is submitted
through the electronic form. Once processed the refund, if any is determined to
be owed, will be paid first to any lienholder. You agree and acknowledge that
any payment to the lienholder will be applied under the terms of your
arrangement with the lienholder. You understand that the refund may be prorated,
and any refund will be less the amount of any claims due to be paid or paid on
your behalf. You understand and acknowledge that additional documentation may be
required to proceed with your cancellation. If additional documentation is
required, you will be notified within 45 days. If additional documentation is
required, the estimated time for processing is an additional 45 days from
submission of the additional documentation.

Indemnity. In consideration of the agreement by Company to act upon the CRF
instructions in the manner provided in these Terms and Conditions, you agree to
indemnify and hold Company harmless from and against any and all claims, suits,
judgments, executions, liabilities, losses, damages, costs, and
expenses–including reasonable attorney’s fees–in connection with or arising out
of Company acting upon those CRF instructions pursuant to these Terms and
Conditions. This indemnity will be effective to relieve and indemnify Company
against its negligence or misconduct.



Terms and Conditions for Funds Transfers

By requesting a funds transfer order with Swickard Auto Group, its affiliates,
or its subsidiaries (the “Company”), you agree to the following:

Reliance by Company. Company may rely on the information on the form received by
it in making your funds transfer. Any errors in the information, including
misidentification of Beneficiary(ies), Recipient(s), incorrect or inconsistent
account names and numbers, identifying numbers of the intermediary bank or
Beneficiary Bank, and misspellings, are your responsibility. If you identify a
Beneficiary or other entity by name and account or any other number, payment may
be made on the basis of the number and your payment will be final even if the
number you provided does not correspond to your Beneficiary or other entity that
you have identified.

Bank Fees. Your financial institution may be authorized to debit your account
for any fees, costs, or charges related to your funds transfer order. You may
have further authorized your financial institution to charge your account a
service fee for each funds transfer order you place in accordance with its fee
schedule in effect from time to time

Transfer of Beneficiary Bank. When you place an order with Company for a funds
transfer, you must select a financial institution as the Beneficiary Bank for
the transfer. For transfers within the United States, the Beneficiary Bank must
be a member of the Federal Reserve System or a correspondent bank of such a
member, or a Clearing House Interbank Payment System (CHIPS) member. You may
request that the funds be deposited to a particular account at the Beneficiary
Bank. The Beneficiary Bank will be responsible for following your instructions
and for notifying the Beneficiary that the funds are available. After the funds
are transferred to the Beneficiary Bank, they become the property of the
Beneficiary Bank. The Beneficiary Bank is responsible to locate, identify, and
make payment to your Beneficiary. If your Beneficiary cannot be properly
identified, the funds may be returned.

Currency of Transfer. Funds transfers to beneficiaries within the United States
are made only in U.S. dollars. International Funds transfers cannot be
accommodated.

Means of Transfer. Company uses a variety of banking channels and facilities to
make funds transfers but will ordinarily use electronic means. The Company may
choose any conventional means that the Company considers suitable to transfer
your funds to your Beneficiary. Because the Company does not maintain banking
relations with every bank, the Company sometimes uses one or more intermediary
banks to transfer your funds to the Beneficiary Bank. After the Company
transmits your order to an intermediary bank, that bank is responsible to
complete your order.

Recalls/Amendments.You are not able to recall or amend your funds transfer
order. Company will not be liable to you for any loss resulting from any
inability to recall or amend your funds transfer order.

Rejection of an Order. The Company reserve the right to reject your funds
transfer order. The Company may reject your order if you have insufficient
information, the order does not comply with applicable laws, the order is
inconsistent with rules and regulations of the financial institutions involved,
if your order is incomplete or unclear, or if the Company is unable to fulfill
your order for any other reason including but not limited to force majeure
events.

Delays, Non-Execution of Funds Transfer Order. While the Company will handle
your funds transfer order as expeditiously as possible, you agree that Company
will not be responsible for any delay, failure to execute, or mis-execution of
your order due to circumstances beyond Company’s reasonable anticipation or
control– including without limitations any inaccuracy, interruption, delay in
transmission, or failure in the means of transmission, whether caused by
strikes, power failures, equipment malfunctions, or acts or omissions of any
intermediary bank or Beneficiary Bank. Company MAKES NO WARRANTIES, EXPRESS OR
IMPLIED–INCLUDING THE FAILURE OF ANY INTERMEDIARY BANK OR Beneficiary BANK TO
CREDIT YOUR Beneficiary WITH THE AMOUNT OF THE FUNDS TRANSFER AFTER RECEIPT OF
SAME WITH RESPECT TO ANY MATTER.

Claims. You agree that within ninety (90) days after you receive notification
that your funds transfer order has been executed, you will tell Company of any
errors, delays or other problems related to your order. Company will determine
whether an error occurred within 90 days after you contact Company and any error
will be corrected promptly. If Company decides there was no error, a written
explanation will be sent to you. If your funds transfer order is delayed or
erroneously executed as a result of Company’s error, Company’s sole obligation
to you is to pay via check such amounts as may be required by applicable law. In
no event shall Company be responsible for any consequential or incidental
damages or expenses in connection with your order. No interest will be payable
by Company under any circumstances. In any event, if you fail to notify Company
of any claim concerning your funds transfer order within ninety (90) days from
the date that you receive notification that your order has been executed, any
claim by you will be barred under applicable law.

Governing Law.The Agreement will be governed by the laws of the state of Oregon
which is the location through which you initiated this funds transfer and United
States federal law as applicable.

Indemnity. In consideration of the agreement by Company to act upon funds
transfer instructions in the manner provided in this Agreement, you agree to
indemnify and hold Company harmless from and against any and all claims, suits,
judgments, executions, liabilities, losses, damages, costs, and
expenses–including reasonable attorney’s fees–in connection with or arising out
of Company acting upon those funds transfer instructions pursuant to this
Agreement. This indemnity will be effective to relieve and indemnify Company
against its negligence or misconduct

Please use Ref # for future communications.
Failed Reason :
Ok 
Make Payment Again
Note: your contract is still valid at any of our Swickard locations. Please see
them here: www.swickard.com/locations.
Would you still like to continue?
Yes  Cancel

PAYMENT PROCESS

x

CUSTOMER DETAILS

CUSTOMER NAME:

 

EMAIL:



PHONE #:



VIN:



EXPEDITED FEE:

$

CREDIT/DEBIT CARD

ACCEPTED CARDS:

       

HOLDER NAME:

*

CARD NUMBER:

*


EXP DATE:

* MM
 * 01
 * 02
 * 03
 * 04
 * 05
 * 06
 * 07
 * 08
 * 09
 * 10
 * 11
 * 12

* YYYY
 * 2023
 * 2024
 * 2025
 * 2026
 * 2027
 * 2028
   

CVV:

*

Pay

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Form analysis 6 forms found in the DOM

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customer.swickard.com Open in urlscan Pro
40.114.28.3 Public Scan

Form analysis
6 forms found in the DOM