Cancel Outside Policies

Employee Name

Customer Name

Customer Email

Agency Name

Agency Name / Agent Name that we're sending the request to

Cancelled Agency Email

Email of the agent/agency we're sending the Docusign to

Cancelled Agency Fax

Email of the agent/agency we're sending the Docusign to

Company to Cancel

Company We are Sending Cancellation to

Date to Cancel Policies

1st Policy Type

Policies to Cancel

Policy Number only

2nd Policy Type

2nd Policy to Cancel (Optional)

List like this: Policy Type(auto, home, life or whatever line), Policy Number

3rd Policy Type

3rd Policy to Cancel (Optional)

List like this: Policy Type(auto, home, life or whatever line), Policy Number

4th Policy Type

4th Policy to Cancel (Optional)

List like this: Policy Type(auto, home, life or whatever line), Policy Number

5th Policy Type

5th Policy to Cancel (Optional)

List like this: Policy Type(auto, home, life or whatever line), Policy Number

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