Page 1 of 2

Cancellation Request - Dunton Insurance Agency

Request agency review of a cancellation. Do not assume the policy is cancelled until confirmed by the agency or carrier. Consider replacement insurance, lender and contract requirements, and coverage gaps. Office hours: Monday–Friday, 8:30 AM–4:30 PM Eastern. Call 724-776-4646 for time-sensitive agency help.

Full name

Email

Phone

Insurer and policy number

Requested cancellation date and reason

Is replacement insurance in place? Describe any lender or contract requirements.

Submitting this request does not bind, change, or cancel insurance coverage. Requests require review and confirmation by the agency or carrier.

Type YES to acknowledge that the request requires review and confirmation