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Run: Vehicle Service Contract Sale Disclosure Form

Use this Vehicle Service Contract Sale Disclosure Form to document the contract term, mileage cap, deductible, refund terms, and customer acknowledgment in o...

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Disclosure Summary

Customer Name (required)

Enter the name of the customer purchasing or acknowledging the vehicle service contract.

Deal Number (required)

Internal deal jacket reference number.

VSC Provider / Administrator (required)

Name of the service contract provider or administrator.

Contract Term (Months) (required)

Length of the vehicle service contract in months.

Mileage Cap (required)

Maximum mileage covered under the contract.

Deductible Amount (required)

Per-visit or per-repair deductible disclosed to the customer.

Refund and Cancellation Terms

Refund / Cancellation Terms Summary (required)

Summarize the applicable refund or cancellation terms in plain language. Avoid unnecessary PII.

Refund terms were explained to the customer (required)

Confirm that the refund and cancellation terms were disclosed.

Yes No N/A

Customer received a copy of the disclosure (required)

Confirm that the customer was provided a copy for their records.

Yes No N/A

Customer Acknowledgment

Customer acknowledges the vehicle service contract is optional and voluntary (required)

The customer confirms they understand the vehicle service contract is not required to complete the vehicle purchase.

Yes No N/A

Customer Signature (required)

Customer signature acknowledging the disclosed terms.

Signature Date (required)

Date the customer signed the disclosure.

Sales Representative Name (required)

Name of the employee presenting the disclosure.

Sales Representative Signature

Optional employee signature for internal audit trail.

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