Cancellation request form - Mechanical Breakdown Protection, Inc 2026

1. Click ‘Get Form’ to open it in the editor.
2. Select whether you are canceling a Vehicle Service Contract (VSC) or a GAP Contract by checking the appropriate box at the top of the form.
3. Fill in your personal details: Contract Holder's name, city, address, state, zip code, and phone number.
4. Enter your VSC or GAP Contract number, purchase date, email address, vehicle year, make, model, and VIN.
5. Provide the selling dealer's name and address along with lien holder information and loan account number.
6. Indicate the reason for cancellation by checking one of the options provided. If applicable, attach proof for your reason.
7. For VSC cancellations only, include automobile mileage at cancellation and attach proof of mileage.
8. Sign and date the form as the customer. If applicable for VSCs, have the dealership sign as well.
9. Submit the completed form to MBPI/VPI at the provided address or via fax.

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