Authorization and Limited Power of Attorney — Vehicle Add-On Product Cancellation

I, [Customer Full Name], of [Address], appoint [Company LLC] ("Agent") as my limited agent and attorney-in-fact solely to:

1. Request copies of my vehicle retail installment contract, buyer's order, and any add-on product contracts from [Dealer], [Lienholder], and any product provider or administrator;
2. Review whether I received every add-on refund I am owed and the correct amount, and request cancellation of the following products and the refund of any unearned charges still owed: [Product, Provider, Contract #] (list each);
3. Communicate with those parties about the status and calculation of those refunds; and
4. Sign and deliver cancellation forms on my behalf where the provider accepts an agent's signature.

Agent may not: receive, endorse, or deposit any refund payment; change where refunds are sent; take on any debt; or act for me in any other matter. All refunds must be paid to me or to my lienholder as required by the contract or law.

Vehicle: [Year Make Model], VIN [VIN]. Loan ended on [Date] by [payoff/trade-in/refinance/sale/total loss]. Odometer: [miles] as of [date].

This authorization ends on the earlier of 12 months from signing, completion of all listed refunds, or my written revocation sent to [email]. A copy or electronic signature is as valid as the original.

Signature ______ Date ______ (E-signed via [platform], IP/timestamp record attached)

Sample cancellation letter we send on your behalf

Re: Request to Cancel and Refund Unearned Charges
Contract holder: [Customer Name] • Contract #: [###] • Product: [Vehicle Service Contract / Tire & Wheel / GAP / Etch / …]
Vehicle: [Year Make Model], VIN [VIN]

We write on behalf of the contract holder above, under the enclosed signed authorization, to request cancellation of this contract effective [Loan end date or date of this letter] and a refund of all unearned charges as provided in the contract's cancellation provision and applicable [State] law.

The vehicle loan ended on [Date] by [early payoff/refinance/trade-in/sale/total loss]. Please (1) process the cancellation and issue the refund to [Customer Name at Address] [or the lienholder if required]; (2) provide a written refund calculation; (3) send the calculation and refund confirmation to both the contract holder and us as authorized agent; and (4) confirm receipt within 10 business days.