In consideration of this cancellation, I do hereby release and forever discharge the Administrator, Provider,
and Lienholder, and I agree to hold the Administrator, Provider, and Lienholder harmless
from any and all claims, demands, actions and payments arising from or related to the Contract,
except for refund or partial refund of the Contract Purchase Price, if any.
I understand that claims and administrative and cancellations fees set forth in the
Contract may be subtracted from any refund to which I may otherwise be entitled.
I understand any Refund due will be paid to the Lienholder in the
event the loan has not been satisfied, and that I must notify the Administrator within thirty (30) days
if the refund has not been received by me or credited to the Lienholder.
I understand that I may be required to submit additional documentation to the Administrator or
Provider in order to complete the Cancellation Process.