Dealer | Client Forms

Driver's Choice

Remittance Form
Dealer Administrator Agreement
Account Info
Dealer Administrator Cancelation Form
Customer Application
Customer Warranty Booklet
Customer Brochure

Driver's Plus

Remittance Form
Dealer Administrator Agreement
Account Info
Dealer Administrator Cancelation Form
Customer Application
Customer Warranty Booklet
Customer Brochure

Theft Deterrent Systems

Dealer Sign Forms

Dealer Agreement
New Dealer Profile

Customer Contracts

Registration Form 10038 $2,500-$5,000
Registration Form 10038 2.5
Registration Form 10038 5
Registration Form 10038-3
New York Customer Agreement

Cancelable Customer Contracts

Registration Form 10038-5-CA
Registration Form 10038-2.5-CA
Registration Form 10038-CA $2,500-$5,000
Registration Form 10038-3-CA

Administrative Forms

Remittance Register

Brochure

Theft Protection Brochure

Total Loss Protection

Customer Contracts

GAP06 Waiver 125
GAP06 Waiver 150 Ford
GAP06 Waiver 150 Indiana
GAP06 Waiver 150
GAP06 Waiver 150 Toyota

Customer Brochure

Total Loss Protection Brochure

Claim Forms

GAP Claim Form
Vehicle Options Form

Remittance Register

GAP Remittance

Cancelation

GAP Colorado Cancelation Form
GAP Cancellation Request and Release: NV, OR, TX, & UT
GAP Cancellation Form: All other States

Producer Agreement

Producer-Administrator GAP Agreement
Dealer Profile Form

Old Republic

Mepco

Mepco Dealer Agreement
Mepco Dealer Profile
Mepco Detail Instruction Guide
Mepco Customer Contract

Dealer Sign-up Forms

Old Republic VSC Agreement
Old Republic Gap Dealer Agreement
Old Republic New Account Info Sheet
Old Republic W9 Tax Form
Old Republic Independent Dealer New Account Info Sheet

Cancelations

Old Republic Cancelation

F&I

Old Republic Gap Transmittal
Old Republic VSC Trasmittal
Old Republic Enrollment Application

Service

Old Republic Emergency Repair Claim Form

Rates

Old Republic Ford 5 Unlimited
Old Republic Toyota 5 Unlimited

Customer Application

Old Republic Extended Protection Plans Form
Old Republic Extended Protection Plans Terms