Cancel my policy

Policy Cancellation Form

Please cancel my insurance policy on the cancellation date and time shown below. Documentation is required to backdate a cancellation such as an escrow closing statement or bill of sale. My policy information is as follows:

* Indicates required field

Named Insured on the policy *

First

Last

Business Name (if applicable) *

Insurance Company *

Policy Type (home, auto, rental, business, etc.) *

Policy Number *

Requested Cancellation Effective Date at 12:01am *

Reason for canceling my policy *

If the Cancellation Effective Date above is not filled in, or the Policy Cancellation Form is received 30 days or more after the cancellation effective date, then the policy will be cancelled effective the date this policy cancellation form is received in our office. I understand and agree that I cannot present any claims under this policy that occur after the cancellation date. Additionally, it's possible that this policy may incur an earned premium whereby you'll owe a pro-rated balance due to the Insurance Company. They will notify you if this is the case. Often times, policy cancellations create a pro-rated refund of any unearned premium. Refunds usually take 7-10 business days. Make sure that we have your correct address. Please return this form to Shorr Agency.................. My initials: *

You’re always welcome here at Shorr Agency. Thank you for insuring with us!

Signature (Typing your name constitutes your signature) *

Today's Date *

We may contact you to verify your identity, the cancellation date or any other questions that may arise.

Comments *

Submit

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Closed: Weekends & Holidays

888-737-6200 Office
888-713-9072 Fax

Office Location:

30211 Ave. de las Banderas # 200
Rancho Santa Margarita, CA 92688

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Cancel My Policy

Policy Cancellation Form

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