Fill - Free fillable ENDVSAF Service Agreement Registration PDF form

ADDRESS

CITY

NAME

CELL PHONE

STATE

ZIP

(FIRST)

(LAST)

EFFECTIVE DATE

Service Agreement Registration

PRODUCER NAME

ENDVSAF

TERM MONTHS

NOTICE TO CUSTOMER: It is understood if purchasing a vehicle, this Vehicle Service Agreement is not required to obtain financing or to purchase

a Vehicle. This Service Agreement is not an insurance policy, a Warranty, or a guarantee. The Agreement Retail Price may be paid in full or financed

with an approved payment option allowed by Us. This Agreement represents the entire Agreement between You and Us. No person has the authority

to change this Agreement or to waive any of its provisions. No other written or oral statements apply to this Agreement.

MANDATORY WAITING PERIOD: It is understood that a 30 Mandatory Waiting Period applies to this Agreement from the Agreement Effective Date.

30 days will be added to end of the Term of Your Agreement. (EMERGENCY ROADSIDE SERVICE, PROMOTIONAL REWARDS AND TRIP INTERRUPTION

BENEFITS ARE AVAILABLE ON THE AGREEMENT EFFECTIVE DATE.)

PAYMENT PLAN PROVIDER (optional): If this Agreement was purchased on a payment plan, the Producer and or Payment Plan Provider listed on

this registration page shall be entitled to any refunds resulting from cancellation of this Agreement for any reason. Failure to make monthly payments

in a timely manner may result in cancellation of this Agreement; no refund will be due and no claims will be authorized.

By signing below You understand and agree to all of the terms and conditions described in this Agreement. You understand that purchase of this

Agreement is voluntary and is not insurance.

Emergency Roadside Services administered by: QUEST TOWING SERVICES, LLC

In Alabama and Utah by Quest Towing, Inc., all entities being individually and collectively

referred to as Quest Towing Services

Address: 106 W. Tolles Drive, Saint Johns, MI 48879

All other benefits are administered by: AXIOM PRODUCT ADMINISTRATION LLC:

Administrative Address: 8651 HWY N, SUITE 201, LAKE ST. LOUIS, MO 63367

For Emegency Roadside Service or Claims, call: 1-833-220-0680

To report an Identity Theft, call: 1-866-399-4389

RETAIL PRICE

PRODUCER REPRESENTATIVE NAME

END-VSA-F 5/19

VIN

YEAR

MAKE

MODEL

ODO

Page 1 of 8

PAID BY CUSTOMER

PAID BY PRODUCER*

If the Retail Price is paid by the Producer, You will not be entitled to a refund if cancelled.

CUSTOMER INFORMATION

AGREEMENT INFORMATION

PRODUCER INFORMATION

CUSTOMER SIGNATURE

DATE

SIGNATURE

VEHICLE INFORMATION

PAYMENT PLAN PROVIDER

PHONE NUMBER

ADDRESS

CITY

STATE

ZIP

NAME

FINANCED

PAID IN FULL

SAPE2212671-EC

JAMES

WINTERBOTTOM

702-580-5963

BIKERJ@GMAIL.COM

3416 Saint Aiden St

Las Vegas

89129

09/18/2020

$0.00

1FTRW08LX3KD80137

2003

FORD

F150 SUPERCREW

115663

Endurance - Direct to Consumer

08/19/2020

END-VSA-F 5/19

Page 2 of 8

A. DEFINITIONS

ADMINISTRATOR, WE, US, AND OUR: For Roadside Service Benefits: Quest Towing Services. For Identitiy Theft: Car Dealer Benefits. For all other

benefits: Axiom Product Administration LLC,: Administrative address: 8651 Hwy. N, Suite 201, Lake St. Louis, MO 63367, 1-833-220-0680.

AGREEMENT: This Vehicle Service Agreement, which You have purchased for Your Vehicle.

COMMERCIAL USE: Any vehicle used for

police or law enforcement services, fire, ambulance or emergency services, taxi, rideshare (such as Uber,

Lyft, etc.), limousine or shuttle services, pick up and/or delivery operations, racing, newspaper or mail delivery, rental services, construction, security

services, snow removal or plowing, cable or line installation, or hauling for hire.

EFFECTIVE DATE: The date in which You purchased this Agreement and Your coverage becomes effective. It is listed on the Registration Page under

the Service Agreement Information section.

OBLIGOR: Axiom Product Administration, 1 PROGRESS POINT PARKWAY, SUITE 101, O’FALLON, MO 63368, (844) 252-0937.

PRODUCER: The seller of this Agreement as listed in the Producer Information section of the Registration Page

ROAD HAZARD: Road debris on the road’s surface such as rocks, trash, nails, glass, steel plates, etc., or road surface conditions such as, potholes,

sinkholes, cracks etc., that results in damage to Your Vehicle.

TERM: The Term of this Agreement is 12 months from the Effective Date listed on the Registration Page.

VEHICLE: The covered Vehicle listed under the Vehicle Information section on the Registration Page. All coverages apply to the Vehicle only, except

Emergency Roadside Service which covers the Vehicle and You when You are the passenger or driver of another vehicle.

YOU OR YOUR: The customer named as the Service Agreement Holder on the Registration Page.

B. WHAT YOUR AGREEMENT COVERS

A. TIRE REPAIR AND REPLACEMENT (This benefit is administered by Axiom Product Administration)

Your Tires are only eligible for repair or replacement benefits if the tire’s tread depth is greater than 2/32 of an inch at the time the covered

Road Hazard incident occurs. If the tread depth of the damaged tire is less than 2/32 of an inch at the time the Road Hazard incident occurs, it

is considered to be unsafe for normal operation according to TIA safety standards and is not eligible for repair or replacement under this benefit.

Oversized and off-road tires are specifically excluded from coverage. The benefits in this section are afforded to You only in the event Your Vehicle

incurs damage due to a covered Road Hazard incident. Our benefits are a “repair” benefit first, meaning We will use Tire Industry Association (TIA)

approved repair methods and services to repair Your tire. If Your tire is deemed unrepairable, We will pay the cost of the tire replacement subject

to the terms, conditions, and limits below.

TIRE REPAIR: If the covered tire can be safely repaired according to TIA repair standards, We will pay the cost of the tire repair subject to the

terms, conditions and limits, in this benefit section. It is not necessary to contact Us before having a tire repaired. The maximum amount payable

for tire repair is $50 per occurrence. You are responsible for any amounts exceeding this per occurrence limit.

TIRE REPLACEMENT: If the covered tire cannot be safely repaired per Tire Industry Association (TIA) standards, due to circumstances such as

side wall punctures, tears, punctures too large to be patched, tire manufacturer safety or performance requirements, We will pay the cost of the

tire replacement subject to the terms, conditions, and limits, in this benefit section. When tires are not repairable, tires will be replaced with new

tires of the same specifications of like, kind, and quality. Replacement tire costs will not exceed the lesser of the Manufacturer’s Suggested Resale

Price (MSRP) or the advertised price of the servicing facility for the covered tire being replaced. We reserve the right to ship replacement tires if the

cost of the local repair facility exceeds national MSRP averages or Our discounted national repair pricing is less. The maximum amount payable for

tire replacement is $125 per occurrence. You are responsible for any amounts exceeding this per occurrence limit.

This is a reimbursement only benefit. For reimbursement, mail Your paid invoice, Your repair order and a copy of Your Registration Page to Us at

8651 Hwy. N, Suite 201, Lake St. Louis, MO 63367, within 60 days of claim origination. The Tire Repair and Tire Replacement benefits combined

are limited to 2 occurrences for the Term of this Agreement.

B. KEY/FOB REPAIR OR REPLACE (This benefit is administered by Axiom Product Administration)

In the event You damage, destroy, or lose Your Key, and/or, Key FOB for Your Vehicle, We will reimburse You up to $500 per incident for the repair

or replacement of an OEM (or like, kind/quality replacement) Key/FOB/Remote. Your benefit amount can be used for the reasonable repair

or replacement costs of: key inserts, metal key charge, key housing, remote housing/transmitter, bluetooth replacement and any related Vehicle

reprogramming expenses.

This is a reimbursement only benefit. For reimbursement mail Your paid invoice, Your repair order, and a copy of Your Registration Page to Us at

8651 Hwy. N, Suite 201, Lake St. Louis, MO 63367, within 60 days of claim origination. This benefit is limited 1 use for the Term of this Agreement.

C. TRIP INTERRUPTION (This benefit is administered by Axiom Product Administration)

We will reimburse You up to a maximum of $150 per day for a maximum of 4 days, not to exceed a total of $600, for expenses incurred by You

for meals and/or lodging, provided: You cannot operate Your Vehicle due to a Vehicle disablement and You are more than 100 miles away from

Your permanent, and expenses are incurred between the time of the Vehicle disablement and the time repairs are completed. (The date of the

Vehicle disablement shall be considered the first day). 1 day’s trip interruption expense shall be allowed for each eight hours, or portion thereof,

of required manual flat-rate labor time.

This is a reimbursement only benefit. For reimbursement mail Your paid invoice, Your repair order, and a copy of Your Registration Page to Us at

8651 Hwy. N, Suite 201, Lake St. Louis, MO 63367, within 60 days of claim origination.

D. PROMOTIONAL REWARDS AND DISCOUNTS (This benefit is administered by Optimus Rewards)

You are entitled to receive promotional rewards with this purchase, in the form of $250 in Reward Dollars, which You can use to save on things like

shopping, dining, and travel. You access and use Your rewards and related benefits all via online or mobile device at www.mydigitalvehiclerewards.

com. Action on Your part is required to use Your rewards. Your rewards are free to You. You are under no obligation to use Your rewards. As long

as You have an active Agreement, and as long as You have a reward balance. Your rewards are not gift cards or gift certificates and have no cash

value. Your rewards are not for re-sale and are subject to change and availability.

E. ID THEFT PROTECTION (This benefit is administered by Car Dealer Benefits)

Upon reporting Your identity theft to Us, We will send you an emergency response kit. We will assist You with restoring Your credit and good repu-

tation. We will administer the costly steps required to properly dispute fraudulent debts as a result of identity theft, create a case file to document

actions taken during the resolution/recovery process, and prepare all necessary documents and letters. You will have unlimited access to Our

team of Fraud Resolution Specialist (FRS). Each FRS is an experienced fraud representative and has been trained under the Fair Credit Reporting

Act (FCRA). Each FRS is also educated and familiar with prohibited “collection” company activities under the Fair Debt Credit Protection Act (FDC-

PA). We will also provide Tax Fraud Assistance through our staffed CPA’s and Enrolled Agents, and via Power of Attorney, we are able to help You

by working directly on Your behalf with the IRS. We maintain a $25,000 expense reimbursement policy to cover reasonable and necessary costs

incurred by You in the United States for long distance phone calls and postage solely as a result of Your efforts to report a stolen identity event

and/or amend or rectify records as to Your true name and/or identity as a result of a stolen identity event. This also includes re-filing applications

for loans, grants, or other credit instruments. In addition, We will provide $500 per week for lost wage reimbursement for a maximum of 4 weeks.

ID Theft Protection is available for up to a family of 4 residing at Your address. To report an Identity Theft call 1-866-399-4389.

F. DIGNIFI

We provide you access to DigniFi who will provide you auto repair loans when you incur unforeseen auto repair expenses. DigniFi offers repair

loans with, no money down and competitive interest rates. Visit DigniFi.com for further details to obtain information regarding a repair loan for

Your Vehicle repairs.

G. EMERGENCY ROADSIDE SERVICE (This benefit is administered by Quest Towing Services)

All Emergency Roadside Service is administered by Quest Towing Services, 106 W. Tolles Drive, Saint Johns, MI 48879, 1-833-220-0680. In the

END-VSA-F 5/19

Page 3 of 8

event Your Vehicle or any vehicle to which You are a driver or passenger experiences a mechanical breakdown or disablement, and is in need of:

a. Towing or jumpstart,

b. Flat tire change (with inflated Spare),

c. Fluid delivery (oil, water, or fuel **Cost of uids not included), or

d. Lock out assistance (entry into passenger compartment only),

We will dispatch a service provider to Your location. Your benefit includes “sign & drive” services under this Agreement. *Sign & drive means You

incur no out of pocket expenses. If You arrange for service on Your own and do not utilize sign & drive services provided by Quest Towing Services

the maximum reimbursement for which You are eligible is limited to $50 per use/incident. The towing benefit included is limited to 25 miles per

occurrence, any expense incurred for towing Your Vehicle over 25 miles will be Your responsibility. Your benefit coverage allows for a maximum

of 1 use per any 72-hour period. All receipts must be submitted to Us within 60 days of incident. 24-hour Roadside Service is provided to You as

long as Your Agreement is active, and is available by calling 1-833-220-0680. Please provide the dispatcher with Your Agreement Number (which

is on the top right of Your Enrollment Page).

Emergency Roadside services are provided only for unmodied single rear-axle, four wheeled registered and licensed light duty

motor vehicles weighing less than 9,500 lbs./4,300 kg used for private, on-road transportation, including passenger vehicles and

light duty trucks.

Emergency Roadside services are provided to You in emergency situations only when Your Vehicle or any vehicle to which You are

a driver or passenger (due to an unforeseen disablement or unavoidable incident) is unable to be driven safely. Services are not

designed to be provided when the disablement is caused by poor or non-existent vehicle maintenance nor does this benet cover

services required for Your Vehicle due to an automobile accident or damage incurred by acts of nature such as: oods, hurricanes,

tornadoes, earthquakes, and hail.

Services provided by Quest Towing Services will not be available in areas not regularly traveled, such as vacant lots, beaches,

open elds, roads closed during the season of the request, or other places which would be hazardous for the Service Provider to

reach.

D. YOUR RESPONSABILITIES

All benefits are available to You up to the specified benefit limit. You are responsible for any amounts over the maximum benefit allowed per the terms

of this Agreement. Your are responsible for submitting all requested documentation for reimbursement within 60 day of covered claim origination.

E. EXCLUSIONS

This Agreement will not pay or reimburse You for any of the following:

1. Any damage caused by collisions/auto accidents, vandalism, acts of God including severe weather.

2. Any damage resulting from acts of fraud, theft, neglect, or Vehicle misuse.

3. Any vehicle driven for Commercial Use.

4. Any pre-existing conditions that existed prior to the Agreement Eective Date.

5. Damage resulting from o Road operation of Vehicle.

6. Any claim outside the United States or Canada.

7. Any damage that is covered by Your auto insurance coverage.

F. HOW TO MAKE A CLAIM

1. To file for claim reimbursement for all other covered benefits except ID Theft, call or submit reimbursement documentation to Axiom Product

Administration, 8651 Hwy. N, Suite 201, Lake St. Louis, MO 63367, 1-833-220-0680.

2. To Report an Identity Theft call 1-866-399-4389.

G. CANCELLATION AND TRANSFER

1. CANCELLATION BY YOU: You may cancel this Agreement at any time. To cancel, You must submit a written request to the Producer or directly

to Us. If You cancel this Agreement within the first 30 days of the Effective Date We will refund Your entire Agreement Retail Price. If You cancel

this Agreement after the first 30 days of the Effective date, We will refund the unearned Agreement Retail Price, less a $50 administrative fee, and

less any paid claims. The unearned Agreement Retail Price will be calculated on a pro-rata basis based on the unused Term Months. If the Retail

Price was paid by the Producer any refund will be issued to the Producer, You will not be entitled to a refund.

2. CANCELLATION BY US: We may cancel Your Agreement for any reason in the first 30 days. After 30 days we may only cancel for (a) non-payment

of the Agreement Retail Price, or if the monthly payments under any payment plans used to finance the purchase of Your vehicle service Agreement

have not been made in a timely manner; (b) a material misrepresentation made by You; or (c) a substantial breach of duties by You relating to Your

Agreement. If We cancel this Agreement We will refund You 100% of the Agreement Purchase Price, less any paid or pending claims.

3. TRANSFER: This Agreement is non-transferable.

H. OBLIGATIONS

Obligations under this Agreement are insured under an insurance policy issued by Lyndon Southern Insurance Company, 10151 Deerwood Park Blvd.,

Bldg. 100, Ste. 500, Jacksonville, FL 32256, Tel: (800) 888-2738, except in California, Georgia, New York, Rhode Island and Wisconsin.

In Georgia, obligations under this Agreement are insured under an insurance policy issued by the Insurance Company of the South, 10151 Deerwood

Park Blvd., Bldg. 100, Ste. 500, Jacksonville, FL 32256, Tel: (800) 888-2738.

In New York, Rhode Island, and Wisconsin, obligations under this Agreement are insured under an insurance policy issued by Atlantic Specialty Insur-

ance Company, 605 North Highway 169, Suite 800, Plymouth, MN 55441, Tel: (800) 888-2738.

In the event the Obligor fails to pay an authorized claim within 60 days after proof of loss has been filed, You may file a direct claim with Lyndon

Southern Insurance Company, Insurance Company of the South, or Atlantic Specialty Insurance Company. To do so, please call the following toll–free

number for instructions: (800) 888-2738.

I. ARBITRATION

Any controversy or claim arising out of or relating to this Agreement, or breach thereof, will be settled by binding arbitration in accordance with

the Commercial Arbitration Rules of the American Arbitration Association at the time of the dispute. A judgment upon the award rendered by the

arbitrator(s) may be entered into any court having jurisdiction thereof. The parties specifically agree to the binding nature of the arbitration, unless

the law of resident State, at the time of purchase, dictates otherwise.

J. STATE AMENDMENTS

These special state disclosures apply if Your Agreement was delivered in one of the following states.

ALABAMA: Section G., Cancellation is amended by deleting items 1. and 2. and replacing it with the following:

1. CANCELLATION BY YOU: You may cancel this Agreement at any time. To cancel, You must submit a written request to the Producer or directly

to Us. If You cancel this Agreement within the first 30 days of the Effective Date We will refund Your entire Agreement Retail Price. The right to

void this Agreement only applies to You and only if no claim has been made. A 10% per month penalty shall be added to any refund that is not

paid or credited within 45 days after the return of this Agreement to Us. If You cancel this Agreement after the first 30 days of the Effective date,

We will refund the unearned Agreement Retail Price, less a $25 administrative fee. The unearned Agreement Retail Price will be calculated on a

pro-rata basis based on the unused Term Months. If the Retail Price was paid by the Producer any refund will be issued to the Producer, You will

not be entitled to a refund.

2. CANCELLATION BY US: We may cancel this Agreement based on one or more of the following reasons: (a) non-payment of the Purchase Price;

END-VSA-F 5/19

Page 4 of 8

(b) a material misrepresentation made by You; or (c) a substantial breach of duties by You relating to the Vehicle or its use. If We cancel this

Agreement, We will refund You 100% of the Agreement Purchase Price. If We cancel this Agreement for any reason other than non-payment or

material misrepresentation We shall mail a written notice to You written notice of cancellation at Your last known address at least 5 days prior to

the cancellation effective date.

ARIZONA: Section E., Exclusions, is amended by deleting item 4. and replacing it with the following:

4. ANY PRE-EXISTING MECHANICAL PROBLEMS KNOWN TO YOU THAT EXISTED PRIOR TO THE PURCHASE OF THIS AGREEMENT OR

CONSEQUENTIAL DAMAGES THAT RESULT FROM THE FAILURE OF A NON-COVERED COMPONENT.

Section G., Cancellation is amended by deleting item 1. and replacing it with the following:

1. CANCELLATION BY YOU: You may cancel this Agreement at any time. To cancel, You must submit a written request to the Producer or directly

to Us. If You cancel this Agreement within the first 30 days of the Effective Date We will refund Your entire Agreement Retail Price. If You cancel

this Agreement after the first 30 days of the Effective date, We will refund the unearned Agreement Retail Price, less a $50 administrative fee..

The unearned Agreement Retail Price will be calculated on a pro-rata basis based on the unused Term Months. If the Retail Price was paid by the

Producer any refund will be issued to the Producer, You will not be entitled to a refund.

Section H. Obligations, is deleted and replaced with the following:

Obligations under this Contract are insured under an Insurance Policy issued by Lyndon Southern Insurance Company, 10151 Deerwood Park

Blvd., Bldg. 100, Ste. 500, Jacksonville, FL 32256, Tel: (800) 888-2738. In the event We cease to operate, are bankrupt or Your claim is not paid

within 30 days after proof of loss has been filed, You may file a direct claim with Lyndon Southern Insurance Company.

Section I., Arbitration, is amended by adding the following:

Arbitration does not prohibit You from following the process to resolve complaints under the provisions of A.R.S. §20-1095.09m, Unfair Trade

Practices, as outlined by the Arizona Department of Insurance. To learn more about this process, You may contact the Arizona Department of

Insurance at 2910 N. 44th Street, 2nd Fl., Phoenix, Arizona 85018-7256, Attn: Consumer Affairs. You may directly file any complaint with the

A.D.O.I. against a service company issuing an approved service Agreement under the provisions of A.R.S. §§20-1095.04 and/or 20-1095.09 by

contacting the Consumer Affairs Division of the A.D.O.I., toll free phone number 1-800-325-2548.

COLORADO: Section H., Obligations, is amended by adding the following:

Obligations under this Contract are guaranteed by reimbursement insurance policy issued by Lyndon Southern Insurance Company, 10151

Deerwood Park Blvd., Bldg. 100, Ste. 500, Jacksonville, FL 32256, Tel: (800) 888-2738

CONNECTICUT: The following disclosure is added to this Agreement:

If the Vehicle is in repair at the time this Contact expires, the expiration date will be automatically extended until the repair is complete.

Section G., Cancellation item ., is amended by adding the following:

You may cancel this Agreement at any time, including if You return the Vehicle or if the Vehicle is sold, lost, stolen, or destroyed.

Section H., Obligations, is amended by adding the following:

You may file a claim with Lyndon Southern Insurance Company, 10151 Deerwood Park Blvd., Bldg. 100, Ste. 500, Jacksonville, FL 32256, Tel:

(800) 888-2738, if We fail to perform according th the therms of this Contract.

Section I., Arbitration is amended by adding the following:

If We are unable to resolve any disputes with You regarding this Agreement, You may file a written complaint with the State of Connecticut

Insurance Department, P.O. Box 816, Hartford, Connecticut 06142-0816, Attention: Consumer Affairs. The written complaint must contain a

description of the dispute, the Purchase Price of the Vehicle, the cost of repair the Vehicle, and a copy of this Agreement.

GEORGIA: Section G., Cancellation items 1. and 2., are deleted and replaced with the following:

1. CANCELLATION BY YOU: You may cancel this Agreement at any time. To cancel, You must submit a written request to the Producer or directly

to Us. If You cancel this Agreement within the first 30 days of the Effective Date We will refund Your entire Agreement Retail Price. If You cancel

this Agreement after the first 30 days of the Effective date, We will refund the unearned Agreement Retail Price. The unearned Agreement Retail

Price will be calculated on a pro-rata basis based on the unused Term Months. If the Retail Price was paid by the Producer any refund will be issued

to the Producer, You will not be entitled to a refund.

2. CANCELLATION BY US: We may cancel this Agreement based on one or more of the following reasons: (a) non-payment of the purchase price;

(b) a material misrepresentation made by You; or (c) fraud by You relating to the Vehicle or its use. If We cancel this Agreement, We will refund

You 100% of the Agreement Purchase Price. If We cancel this Agreement for any other reason other than non-payment of the Purchase Price, We

will mail You written notice of cancellation at least 30 days prior to the effective date of cancellation. If We cancel this Agreement, We will provide

any refund due on or before the effective date of cancellation. All cancellations shall be in accordance with O.C.G.A. § 33-24-44.

Section E., Exclusion Item 4.is deleted and replaced with the following:

4. ANY PRE-EXISTING MECHANICAL PROBLEMS THAT EXISTED PRIOR TO THE EFFECTIVE DATE OF THIS Agreement AND WERE KNOWN

TO YOU OR CONSEQUENTIAL DAMAGES THAT RESULT FROM THE FAILURE OF A NON-COVERED COMPONENT.

Section I., Arbitration, is deleted in its entirety.

HAWA

II: Section G., Cancellation item 1., is deleted and replaced with the following:

1. CANCELLATION BY YOU:You may cancel this Agreement at any time. To cancel, You must submit a written request to the Producer or directly

to Us. If You cancel this Agreement within the first 30 days of the Effective Date We will refund Your entire Agreement Retail Price. The right to

cancel this Agreement in the first 30 days and receive a full refund only applies to the original purchaser and is non-transferable. If We do not

provide Your applicable refund within 45 days of the effective date of cancellation, a 10% penalty per month will be added to the amount of the

refund. If You cancel this Agreement after the first 30 days, or if a claim has been made within the first 30 days, We will refund the unearned

Purchase Price calculated on a pro-rata basis determined by the months remaining, less a $50 administrative fee and less any paid or pending

claims. If the Retail Price was paid by the Producer any refund will be issued to the Producer, You will not be entitled to a refund.

IDAHO: The following disclosure is added to this Agreement:

Coverage afforded under this Agreement is not guaranteed by the Idaho insurance guaranty association.

ILLINOIS: Section G., Cancellation item 1., is deleted and replaced with the following:

1. CANCELLATION BY YOU: You may cancel this Agreement at any time. To cancel, You must submit a written request to the Producer or directly

to Us. If You cancel this Agreement within the first 30 days of the Effective Date We will refund Your entire Agreement Retail Price. If You cancel

this Agreement after the first 30 days of the Effective date, We will refund the unearned Agreement Retail Price, less a $50 administrative fee, or

10% of the Agreement Purchase Price, whichever is less. The unearned Agreement Retail Price will be calculated on a pro-rata basis based on the

unused Term Months. If the Retail Price was paid by the Producer any refund will be issued to the Producer, You will not be entitled to a refund.

INDIANA: The following disclosures are added to this Agreement:

This Agreement is not insurance and is not subject to Indiana Insurance law.

IOWA: The following disclosure is added to this Agreement:

You may contact the Iowa Commissioner of Insurance at 601 Locust St., 4th Floor, Des Moines, IA 50309.

END-VSA-F 5/19

Page 5 of 8

Section G., Cancellation item 1., is deleted and replaced with the following:

1. CANCELLATION BY YOU: You may cancel this Agreement at any time. To cancel, You must submit a written request to the Producer or directly

to Us. If You cancel this Agreement within the first 30 days of the Effective Date We will refund Your entire Agreement Retail Price. The right to

cancel and receive a full refund only applies to the original purchaser and is non-transferable. A 10% penalty per month shall be added to a refund

that is not paid within 30 days of the return of this Agreement. If You cancel this Agreement after the first 30 days of the Effective date, We will

refund the unearned Agreement Retail Price, less a $50 administrative fee, and less any paid claims. The unearned Agreement Retail Price will be

calculated on a pro-rata basis based on the unused Term Months. If You cancel we shall mail a written notice of cancellation to You within 15

days of the effective date of cancellation. If the Retail Price was paid by the Producer any refund will be issued to the Producer, You will not be

entitled to a refund.

MAINE: Section G., Cancellation items 1. is deleted replaced with the following:

1. CANCELLATION BY YOU: CANCELLATION BY YOU: You may cancel this Agreement at any time. To cancel, You must submit a written request

to the Producer or directly to Us. If You cancel this Agreement within the first 30 days of the Effective Date We will refund Your entire Agreement

Retail Price. The right to cancel this Agreement in the first 60 days and receive a full refund, less any paid or pending claims only applies to the

original purchaser and is non-transferable. If We do not provide Your refund within 45 days of the effective date of cancellation a 10% per month

penalty will be added the refund. If You cancel this Agreement after the first 30 days o, We will refund the unearned Purchase Price calculated on

a pro-rata basis determined by the months remaining, less an administrative fee of $50 or 10% of the Purchase Price, whichever is less, and less

any paid or pending claims. If the Retail Price was paid by the Producer any refund will be issued to the Producer, You will not be entitled to a

refund.

Section G., Cancellation, item 2., is amended by adding the following:

If We cancel this Agreement, We will mail written notice to you at least 15 day prior to the effective date of cancellation stating the date and reason

for cancellation.

MARYLAND: The following disclosures are added to this Agreement:

If the Vehicle is in repair at the time this Agreement expires, the expiration date will be automatically extended until the repair is complete. If

We fail to perform as outlined in this Agreement prior to the expiration of this Agreement, this Agreement will not terminate and the expiration

date shall be extended until Our obligations are complete pursuant to the terms and conditions of this Agreement.

Section G., Cancellation items 1. is deleted replaced with the following:

1. CANCELLATION BY YOU: You may cancel this Agreement at any time. To cancel, You must submit a written request to the Producer or directly

to Us. If You cancel this Agreement within the first 30 days of the Effective Date We will refund Your entire Agreement Retail Price. The right to

cancel this Agreement in the first 60 days and receive a full refund, less any paid or pending claims only applies to the original purchaser and is

non-transferable. If We do not provide Your refund within 45 days of the effective date of cancellation a 10% per month penalty will be added to

the refund. If You cancel this Agreement after the first 30 days of the Effective date, We will refund the unearned Agreement Retail Price, less a

$50 administrative fee, and less any paid claims. The unearned Agreement Retail Price will be calculated on a pro-rata basis based on the unused

Term Months. If the Retail Price was paid by the Producer any refund will be issued to the Producer, You will not be entitled to a refund.

MASSACHUSETTS: The following disclosures are added to this Agreement:

NOTICE TO YOU: PURCHASE OF THIS AGREEMENT IS NOT REQUIRED IN ORDER TO REGISTER OR FINANCE YOUR VEHICLE. THE BENEFITS PROVIDED

UNDER THIS AGREEMENT MAY DUPLICATE EXPRESS MANUFACTURER’S OR SELLER’S WARRANTIES THAT COME AUTOMATICALLY WITH EVERY SALE.

THE SELLER OF THIS Agreement IS REQUIRED TO INFORM YOU OF ANY WARRANTIES AVAILABLE TO YOU WITHOUT THIS AGREEMENT.

Section G., Cancellation items 1. is deleted replaced with the following:

1. CANCELLATION BY YOU: CANCELLATION BY YOU: You may cancel this Agreement at any time. To cancel, You must submit a written request

to the Producer or directly to Us. If You cancel this Agreement within the first 30 days of the Effective Date We will refund Your entire Agreement

Retail Price. The right to cancel this Agreement in the first 60 days and receive a full refund, less any paid or pending claims only applies to

the original purchaser and is non-transferable. If We do not provide Your refund within 45 days of the effective date of cancellation a 10% per

month penalty will be added to the refund. If You cancel this Agreement after the first 30 days of the Effective date, We will refund the unearned

Agreement Retail Price, less a $50 administrative fee, and less any paid claims. The unearned Agreement Retail Price will be calculated on a pro-

rata basis based on the unused Term Months. If the Retail Price was paid by the Producer any refund will be issued to the Producer, You will not

be entitled to a refund.

MINNESOTA: Section G., Cancellation items 1. is deleted replaced with the following: