Customer Cancellation Request

Bayou Automotive can cancel vehicle protection products electronically. Please complete all the information below and we will process your request. You will receive an email from a Bayou Automotive team member upon completion of the form. Please note the entire cancellation and refund process takes around 6 weeks. If you have any questions during the process, please email cancellations@bayouautomotive.com

Vehicle Information

*Year

*Make

*Model

*VIN

*Miles

Customer Information (name listed on product policy)

*First Name

*Last Name

*Phone

*Email

*City

*State

*ZIP

Products to Cancel

*Type of Policy / Product

*Policy #

Type of Policy / Product

Policy #

Type of Policy / Product

Policy #

*Cancellation Date

*Exact Mileage on Vehicle

Lienholder Information

Is the vehicle currently financed with a bank? Yes No

If YES, please list bank info (this is mandatory)

Bank Name

Account Number

Phone

City

State

ZIP

Cancellation Reason (only select one)

Please email documents requested below to cancellations@bayouautomotive.com. We accept a scanned copy or pictures of the documents.

Traded or Sold (include the following documents)

Need copy of odometer statement, bill of sale, or buyer’s order.
Need proof from lienholder that vehicle is paid off (including VIN number) or a copy of clear title. *If not supplied, refund check will go to lienholder*

Total Loss (include the following documents)

Need document from insurance company showing vehicle date of loss, mileage, and VIN number.
Need proof from lienholder that vehicle is paid off (including VIN number). *If not supplied, refund check will go to lienholder*

Refinanced (include the following documents)

Need copy of the finance agreement from the refinance company.
Need copy of NEW Mechanical Policy (if purchased when vehicle was refinanced).

Customer Request (include the following documents)

If vehicle is NOT PAID OFF, Lienholder Information section (above) must be completed to refund lienholder.
If vehicle is PAID OFF, we need copy of clear title or payoff letter from lienholder (including VIN number) to refund policyholder.

Policyholder Authorization

*“I hereby authorize and request that the Lender/Lessor named above, any successor or assign thereto, any entity servicing my loan or lease or any insurance company providing insurance on the vehicle described herein furnish to Bayou Automotive or its representatives such information about me, my account or my vehicle that Bayou Automotive may request to process this cancellation request. A photo static copy of this authorization shall be considered as valid as the original.”

*Full Name

*Date

Comments

Although every reasonable effort has been made to ensure the accuracy of the information contained on this site, absolute accuracy cannot be guaranteed. This site, and all information and materials appearing on it, are presented to the user "as is" without warranty of any kind, either express or implied. All vehicles are subject to prior sale. Price does not include applicable tax, title, and license charges. ‡Vehicles shown at different locations are not currently in our inventory (Not in Stock) but can be made available to you at our location within a reasonable date from the time of your request, not to exceed one week.

Bayou Ford