Interstate National Dealer Services
    P.O. Box 724707
    Atlanta, GA 31139
    Phone 800-942-0400 Fax 516-227-5971

SERVICE CONTRACT TRANSFER APPLICATION

    Service Contract #:
 

ORIGINAL CONTRACT HOLDER
NEW CONRACT HOLDER
    Name:
 
    Name:
 
    Address:
 
    Address:
 
    City State: Zip:
 
    City State: Zip:
 
    Telephone:
 
    Telephone:
 

VEHICLE DESCRIPTION
    Year:
 
    Make:
 
    Model:
 
    VIN:
 
    Transfer Date:
 
    Odometer Mileage (if applicable) - Transfer Date:
 


PLEASE ENCLOSE TRANSFER FEE OF $50.00
IMPORTANT
TRANSFER MUST BE SUBMITTED WITHIN THE 15 OR 30 DAYS
OF CHANGE OF OWNERSHIP AS SET FORTH IN YOUR CONTRACT

ACKNOWLEDGEMENT
I HEREBY DECLARE THAT I HAVE FULLY READ THE TERMS OF THE SERVICE CONTRACT NAMED ABOVE AND I UNDERSTAND AND ACCEPT ALL OF THE PROVISIONS THEREIN.
 ___________________  ___________________
    Signature Of Original Holder     Date     Signature Of New Owner     Date


TRANSFER PROCEDURE

    Submit the following:
1. Service Contract Transfer Application (above).
2. Bill of sale showing sale date and mileage at time of sale.
3. $50.00 check made payable to Interstate National Dealer Services Inc.

    Special State Requirements:
    Florida
1. Service Contract Transfer Application.
2. Submission of receipts evidencing completion of manufacturer's prescribed lubrication services.
3. A copy of the buyers sales tax receipt.
4. $50.00 check made payable to Interstate National Dealer Services Inc.

V-918 (8/00)