Vehicle Service Contract Sale Disclosure Form

Disclosure form for documenting key vehicle service contract terms, refund conditions, and customer acknowledgment for the deal jacket.

Disclosure Summary

• Customer Name
  Enter the name of the customer purchasing or acknowledging the vehicle service contract.
• Deal Number
  Internal deal jacket reference number.
• VSC Provider / Administrator
  Name of the service contract provider or administrator.
• Contract Term (Months)
  Length of the vehicle service contract in months.
• Mileage Cap
  Maximum mileage covered under the contract.
• Deductible Amount
  Per-visit or per-repair deductible disclosed to the customer.

Refund and Cancellation Terms

• Refund / Cancellation Terms Summary
  Summarize the applicable refund or cancellation terms in plain language. Avoid unnecessary PII.
• Refund terms were explained to the customer
  Confirm that the refund and cancellation terms were disclosed.
• Customer received a copy of the disclosure
  Confirm that the customer was provided a copy for their records.

Customer Acknowledgment

• Customer acknowledges the vehicle service contract is optional and voluntary
  The customer confirms they understand the vehicle service contract is not required to complete the vehicle purchase.
• Customer Signature
  Customer signature acknowledging the disclosed terms.
• Signature Date
  Date the customer signed the disclosure.
• Sales Representative Name
  Name of the employee presenting the disclosure.
• Sales Representative Signature
  Optional employee signature for internal audit trail.