18 Del. Admin. Code § 204
2.1 Prohibitions on "tying"
2.1.1 Any person engaging in the business of insurance in Delaware who has received the name of any actual or potential borrower from any bank or trust company directly or indirectly engaging in any activity authorized by5 Del.C. §761(1)(14)in Delaware shall make the following written disclosure (or a substantially equivalent written disclosure) simultaneously with every application for any product or service to be purchased or obtained in Delaware by such actual or potential borrower from such person:
2.1.2 What We Cannot Do
2.1.2.3 You have applied today to [insert name of entity to whom application submitted] for [describe product or service applied for]. We CANNOT condition our approval (if any) of your application upon:
2.2 Any person engaging in the business of insurance in Delaware who has received the name of any actual or potential borrower from a bank or trust company first authorized to transact the business of insurance in Delaware pursuant to5 Del.C. §761(a)(14)shall make the following written disclosure (or a substantially equivalent written disclosure), immediately following that disclosure required by section 2.1.1 of this regulation, in every application for any insurance policy to be purchased or obtained in Delaware from such person by such actual or potential borrower:
3.2 “Notice of Insurance Cancellation Rights"
3.2.2 You may cancel the insurance you have purchased from us at any time until midnight of the 30th day following our delivery of this notice and the accompanying cancellation form to you (the "Cancellation Period"). If you exercise your right to cancel the insurance within the Cancellation Period, you are entitled to a refund of some or all of the premium you have paid for such insurance, as follows:
3.2.2.2 If, at any time after the 10th day of the Cancellation Period and before the end of the Cancellation Period, you exercise your right to cancel the insurance you have purchased from us, we will, at your option:
3.4 "Cancelation Notice’’
3.4.1 The undersigned, pursuant to the provisions of5 Del.C. Sec. 930,hereby cancels the purchase of insurance obtained from [insert name of selling person], and requests a refund or credit of the premium paid for such insurance, as follows (check only one of the following three alternatives):
3.4.2 If the insurance I am canceling is against loss of, damage to, or liability arising out of the ownership or use of, property which I pledged or otherwise used to secure an extension of credit from [insert name of bank or trust company], I have enclosed with this Cancellation Form a certificate of insurance showing that I have obtained other adequate insurance against such risks, and I understand that [insert name of bank or trust company] has no obligation to honor this Cancellation Form if I have not enclosed such a certificate of insurance.
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Purchaser Signature
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Date of Signature
3.4.3 IMPORTANT NOTICE: THIS CANCELLATION FORM IS EFFECTIVE WHEN DELIVERED TO [insert name of selling person] AT THE FOLLOWING ADDRESS:
[insert address]
4.2 "Your Right to Look to a Delaware Bank or Trust Company for Payment on Any Insurance Policy is Limited By Law” .