diff --git a/src/digital-components/modal/modal.vue b/src/digital-components/modal/modal.vue
index ae21dca2..e9f87bd4 100644
--- a/src/digital-components/modal/modal.vue
+++ b/src/digital-components/modal/modal.vue
@@ -35,17 +35,30 @@
                 </div>
                 <div class="modal-footer px-5 py-4">
                     <modalButtonMain
+                        v-if="useDefaultButton"
                         id="modalbtn"
                         ref="modalButtonMain"
                         isPrimary
                         class="w-100"
                         loaderColor="white"
                         :buttonText="footerButtonText"
-                        :class="
+                        :class="[
                             (isButtonDisabled || isFooterButtonDisabled) &&
-                            'form-test-invalid'
-                        "
+                            'form-test-invalid',
+                            additionalClassesString
+                        ]"
                         @clickEvent="validateAndEmit" />
+                    <button
+                        v-if="!useDefaultButton"
+                        class="w-100 btn d-flex align-items-center justify-content-center delay"
+                        :class="[
+                            (isButtonDisabled || isFooterButtonDisabled) &&
+                            'form-test-invalid',
+                            additionalClassesString
+                        ]"
+                        @click="validateAndEmit">
+                        <span class="m-0">{{ footerButtonText }}</span>
+                    </button>
                 </div>
             </div>
         </div>
@@ -73,7 +86,15 @@ export default {
         onModalClosedCallback: {
             type: Function
         },
-        isButtonDisabled: Boolean
+        isButtonDisabled: Boolean,
+        useDefaultButton: {
+            type: Boolean,
+            default: true
+        },
+        additionalClassesString: {
+            type: String,
+            default: null
+        }
     },
     emits: ['footer-button-event', 'isModalOpened'],
     setup(props) {
@@ -181,6 +202,16 @@ export default {
         z-index: 5;
         border-radius: 0;
         background-color: $gray-100;
+
+        > .navigation-link {
+            color: $black;
+            font-weight: $font-weight-bold;
+            line-height: 1.625rem;
+            white-space: nowrap;
+            align-items: center;
+            text-decoration: underline;
+            text-underline-offset: .3125rem;
+        }
     }
     &.modal-component {
         .modal-dialog {
diff --git a/src/layouts/coverage-statement/__snapshots__/coverage-statement.spec.js.snap b/src/layouts/coverage-statement/__snapshots__/coverage-statement.spec.js.snap
index d0ca1a73..f6f6b40f 100644
--- a/src/layouts/coverage-statement/__snapshots__/coverage-statement.spec.js.snap
+++ b/src/layouts/coverage-statement/__snapshots__/coverage-statement.spec.js.snap
@@ -2,6 +2,7 @@
 
 exports[`coverageStatement.vue returns the initial data 1`] = `
 Object {
+  "CANCEL_CLAIM_REF_NAME": "CancelClaimModal",
   "DEDUCTIBLE_MODAL_REF_NAME": "DeductibleModal",
   "RECAL_MODAL_REF_NAME": "RecalModal",
   "SITE_FOOTER_REF_NAME": "siteFooter",
@@ -12,6 +13,7 @@ Object {
   },
   "selectedProvider": "",
   "widget": Object {
+    "disclaimerText": "DisclaimerWidget",
     "explanatoryText": "ExplanatoryTextWidget",
     "nextStep": "NextStepsWidget",
     "serviceProviderQuestion": "ServiceProviderQuestion",
diff --git a/src/layouts/coverage-statement/cancel-claim-modal/__snapshots__/cancel-claim-modal.spec.js.snap b/src/layouts/coverage-statement/cancel-claim-modal/__snapshots__/cancel-claim-modal.spec.js.snap
new file mode 100644
index 00000000..0efddf79
--- /dev/null
+++ b/src/layouts/coverage-statement/cancel-claim-modal/__snapshots__/cancel-claim-modal.spec.js.snap
@@ -0,0 +1,8 @@
+// Jest Snapshot v1, https://goo.gl/fbAQLP
+
+exports[`returns the initial data 1`] = `
+Object {
+  "isLoaderDisplayed": false,
+  "isModalOpened": false,
+}
+`;
diff --git a/src/layouts/coverage-statement/cancel-claim-modal/cancel-claim-modal.spec.js b/src/layouts/coverage-statement/cancel-claim-modal/cancel-claim-modal.spec.js
new file mode 100644
index 00000000..06e26dba
--- /dev/null
+++ b/src/layouts/coverage-statement/cancel-claim-modal/cancel-claim-modal.spec.js
@@ -0,0 +1,88 @@
+import { shallowMount } from '@vue/test-utils';
+import cancelClaimModal from '@/layouts/coverage-statement/cancel-claim-modal/cancel-claim-modal.vue';
+
+const mockDataStrings = {
+    cmsBodyText: 'Some Body Text from CMS',
+    cmsBodyText2: 'Some Text for Button in Body from CMS',
+    cmsFooterText: 'Some Footer Text from CMS',
+    cmsHeaderText: 'Some Header Text from CMS'
+};
+
+const mockCmsContent = {
+    BodyText: mockDataStrings.cmsBodyText,
+    BodyText2: mockDataStrings.cmsBodyText2,
+    FooterText: mockDataStrings.cmsFooterText,
+    HeaderText: mockDataStrings.cmsHeaderText
+};
+
+const mockMixin = {
+    methods: {
+        getCmsContent: jest.fn((_, cmsFieldName) => mockCmsContent[cmsFieldName])
+    }
+};
+
+function setupMocks() {
+    const wrapper = shallowMount(cancelClaimModal, {
+        mixins: [mockMixin],
+        props: {
+            cmsWidgetName: 'test'
+        },
+        attachTo: document.body
+    });
+
+    return { wrapper };
+}
+
+test('returns the initial data', () => {
+    // Arrange
+    const { wrapper } = setupMocks();
+
+    // Assert
+    expect(wrapper.vm.$data).toMatchSnapshot();
+});
+
+describe('Computed', () => {
+    test('Should get modal body text from Widget CMS', () => {
+        // Arrange
+        const { wrapper } = setupMocks();
+
+        // Act
+        const modalHeader = wrapper.vm.modalBodyText;
+
+        // Assert
+        expect(modalHeader).toBe(mockDataStrings.cmsBodyText);
+    });
+
+    test('Should get modal body text2 from Widget CMS', () => {
+        // Arrange
+        const { wrapper } = setupMocks();
+
+        // Act
+        const modalHeader = wrapper.vm.modalBodyText2;
+
+        // Assert
+        expect(modalHeader).toBe(mockDataStrings.cmsBodyText2);
+    });
+
+    test('Should get modal footer text from Widget CMS', () => {
+        // Arrange
+        const { wrapper } = setupMocks();
+
+        // Act
+        const modalHeader = wrapper.vm.modalFooterText;
+
+        // Assert
+        expect(modalHeader).toBe(mockDataStrings.cmsFooterText);
+    });
+
+    test('Should get modal header text from Widget CMS', () => {
+        // Arrange
+        const { wrapper } = setupMocks();
+
+        // Act
+        const modalHeader = wrapper.vm.modalHeaderText;
+
+        // Assert
+        expect(modalHeader).toBe(mockDataStrings.cmsHeaderText);
+    });
+});
diff --git a/src/layouts/coverage-statement/cancel-claim-modal/cancel-claim-modal.vue b/src/layouts/coverage-statement/cancel-claim-modal/cancel-claim-modal.vue
new file mode 100644
index 00000000..f5d0df9d
--- /dev/null
+++ b/src/layouts/coverage-statement/cancel-claim-modal/cancel-claim-modal.vue
@@ -0,0 +1,102 @@
+<!-- eslint-disable vue/no-v-html -->
+<template>
+    <transition
+        name="fade"
+        mode="out-in">
+        <div class="cancel-claim-modal-container">
+            <modal
+                ref="cancelClaimModal"
+                :headerText="modalHeaderText"
+                :footerButtonText="modalFooterText"
+                additionalClassesString="navigation-link"
+                :useDefaultButton="false"
+                @isModalOpened="setModalStatus"
+                @footerButtonEvent="cancelClaimConfirmation">
+                <div v-html="modalBodyText"></div>
+                <button
+                    id="btnContinueReferral"
+                    type="button"
+                    :aria-disabled="false"
+                    class="btn btn-primary btn-override
+                    align-items-center justify-content-center d-inline-flex mt-4 py-3 px-4 delay w-100"
+                    @click="returnToClaim">
+                    {{ modalBodyText2 }}
+                    <loader
+                        v-if="isLoaderDisplayed"
+                        class="ms-2 button-loader" />
+                </button>
+            </modal>
+        </div>
+    </transition>
+</template>
+
+<script>
+import loader from '@/ux-components/loader/loader.vue';
+import modal from '@/digital-components/modal/modal.vue';
+
+export default {
+    name: 'cancel-claim-modal',
+    components: {
+        loader,
+        modal
+    },
+    emits: ['cancel-claim-confirmation', 'return-to-claim'],
+    data() {
+        return {
+            isLoaderDisplayed: false,
+            isModalOpened: false
+        };
+    },
+    computed: {
+        modalBodyText() {
+            return this.getCmsContent('CancelClaimModal', 'BodyText');
+        },
+        modalBodyText2() {
+            return this.getCmsContent('CancelClaimModal', 'BodyText2');
+        },
+        modalHeaderText() {
+            return this.getCmsContent('CancelClaimModal', 'HeaderText');
+        },
+        modalFooterText() {
+            return this.getCmsContent('CancelClaimModal', 'FooterText');
+        }
+    },
+    methods: {
+        openModal() {
+            this.$refs.cancelClaimModal.openModal();
+        },
+        removeLoader() {
+            this.isLoaderDisplayed = false;
+        },
+        setModalStatus(isOpened) {
+            this.isModalOpened = isOpened;
+        },
+        closeModal() {
+            this.$refs.cancelClaimModal.closeModal();
+        },
+        cancelClaimConfirmation() {
+            this.$emit('cancel-claim-confirmation');
+        },
+        returnToClaim() {
+            this.$emit('return-to-claim');
+        }
+    }
+};
+</script>
+
+<style lang="scss" scoped>
+.btn {
+    &.btn-primary {
+        position: relative;
+        background: linear-gradient(270deg, $blue 0%, $blue-800 100%);
+        border: none;
+        border-radius: $border-radius-lg;
+        color: $white;
+        justify-content: center;
+        font-weight: $font-weight-bold;
+        @media (hover: hover) {
+            background: linear-gradient(270deg, $blue 0%, $blue-800 100%);
+        }
+    }
+}
+</style>
diff --git a/src/layouts/coverage-statement/coverage-statement.spec.js b/src/layouts/coverage-statement/coverage-statement.spec.js
index 048c8bd5..bde3197d 100644
--- a/src/layouts/coverage-statement/coverage-statement.spec.js
+++ b/src/layouts/coverage-statement/coverage-statement.spec.js
@@ -27,6 +27,7 @@ jest.mock('@/helpers/cms-content-helper', () => ({
 }));
 
 const SAFELITE_PROVIDER = 'Safelite';
+const CANCEL_CLAIM_REF_NAME = 'CancelClaimModal';
 
 const mockMixin = {
     methods: {
@@ -91,6 +92,7 @@ function getMountedComponent(mainInitialState = {}, initialData = {}, methodToRu
     fetchCmsContentForPage.mockImplementation(() => Promise.resolve());
 
     const wrapper = shallowMount(coverageStatement, mountOptions);
+    wrapper.vm.$refs[CANCEL_CLAIM_REF_NAME].openModal = jest.fn();
     return { wrapper };
 }
 
diff --git a/src/layouts/coverage-statement/coverage-statement.vue b/src/layouts/coverage-statement/coverage-statement.vue
index 41f6d3b8..5d3dee3a 100644
--- a/src/layouts/coverage-statement/coverage-statement.vue
+++ b/src/layouts/coverage-statement/coverage-statement.vue
@@ -71,9 +71,9 @@
                         isRequired
                         :validationRules="rules.selectionRequired">
                     </buttonQuestion>
-                    <text-block
+                    <textBlock
                         v-if="isQuoteDisplayed"
-                        cmsWidgetName="DisclaimerWidget"
+                        :customText="disclaimerText"
                         typeStyle="caption" />
                     <siteFooter
                         :ref="SITE_FOOTER_REF_NAME"
@@ -93,6 +93,10 @@
             :ref="DEDUCTIBLE_MODAL_REF_NAME"
             cmsWidgetName="DeductibleModal"
             class="deductible-modal" />
+        <cancelClaimModal
+            :ref="CANCEL_CLAIM_REF_NAME"
+            @cancelClaimConfirmation="cancelClaim"
+            @returnToClaim="continueClaim" />
     </Form>
 </template>
 <script>
@@ -101,6 +105,7 @@ import { Form } from 'vee-validate';
 import siteFooter from '@/iss-components/site-footer/site-footer.vue';
 import siteHeader from '@/iss-components/site-header/site-header.vue';
 import alert from '@/ux-components/alert/alert.vue';
+import cancelClaimModal from '@/layouts/coverage-statement/cancel-claim-modal/cancel-claim-modal.vue';
 import contentGroupModal from '@/iss-components/content-group-modal/content-group-modal.vue';
 import buttonQuestion from '@/digital-components/button-question/button-question.vue';
 import textBlock from '@/digital-components/text-block/text-block.vue';
@@ -127,6 +132,7 @@ import { getPriceOfLineItems } from '@/helpers/price-calculator';
 import coverageStatuses from '@/constants/coverage-statuses';
 import coverageType from '@/constants/coverage-type';
 
+const CANCEL_CLAIM_REF_NAME = 'CancelClaimModal';
 const SAFELITE_PROVIDER = 'Safelite';
 const RECAL_MODAL_REF_NAME = 'RecalModal';
 const DEDUCTIBLE_MODAL_REF_NAME = 'DeductibleModal';
@@ -140,6 +146,7 @@ export default {
         // eslint-disable-next-line vue/no-reserved-component-names
         Form,
         alert,
+        cancelClaimModal,
         contentGroupModal,
         buttonQuestion,
         textBlock
@@ -164,7 +171,7 @@ export default {
             }
         ];
 
-        const { vehicle, isITAC, isDeductible, serviceLocation } = store;
+        const { isITAC, isDeductible, serviceLocation } = store;
         if (isITAC || isDeductible) {
             promiseResultMap.push({
                 resultKey: 'getFinalDeductible',
@@ -205,12 +212,14 @@ export default {
                 selectionRequired: globalRules.OPTION_REQUIRED
             },
             widget: {
+                disclaimerText: 'DisclaimerWidget',
                 subheader: 'SiteSubHeaderWidget',
                 verifiedItacAlert: 'VerifiedITACAlert',
                 explanatoryText: 'ExplanatoryTextWidget',
                 nextStep: 'NextStepsWidget',
                 serviceProviderQuestion: 'ServiceProviderQuestion'
             },
+            CANCEL_CLAIM_REF_NAME,
             RECAL_MODAL_REF_NAME,
             DEDUCTIBLE_MODAL_REF_NAME,
             SITE_FOOTER_REF_NAME
@@ -237,7 +246,6 @@ export default {
                 widgetFields.ALERT_WIDGET.BODY_TEXT
             )?.replaceAll(
                 '{custom:costSavings}',
-
                 formatAmountInDollars(itacCostSavings)
             );
         },
@@ -247,6 +255,12 @@ export default {
                 widgetFields.SUB_HEADER_WIDGET.SECONDARY_TEXT
             );
         },
+        disclaimerText() {
+            return this.getCmsContent(this.widget.disclaimerText, widgetFields.TEXT_BLOCK_WIDGET.TEXT)?.replaceAll(
+                '{custom:disclaimerAmount}',
+                formatAmountInDollars(this.totalServicePrice)
+            );
+        },
         explanatoryText() {
             return this.getTextFromCmsWithCustomIfStatements(
                 this.widget.explanatoryText,
@@ -331,11 +345,9 @@ export default {
     },
     watch: {
         selectedProvider() {
-            const buttonText =
-                this.selectedProvider === SAFELITE_PROVIDER
-                    ? 'Continue with Safelite'
-                    : 'Continue';
-            this.$refs[SITE_FOOTER_REF_NAME].updateButtonText(buttonText);
+            if (this.selectedProvider && this.selectedProvider !== SAFELITE_PROVIDER) {
+                this.$refs[this.CANCEL_CLAIM_REF_NAME].openModal();
+            }
         },
         nextStepsBody(newValue, oldValue) {
             if (newValue !== oldValue) {
@@ -462,7 +474,16 @@ export default {
         setBaseServiceLineItems(lineItems) {
             this.baseServiceLineItems = lineItems;
         },
-        formatAmountInDollars
+        formatAmountInDollars,
+        cancelClaim() {
+            useMainStore().updateIsSafeliteProvider(false);
+            useMainStore().setBailout(bailoutMessage.RequestCallback());
+            this.navigateWithScenario(navigationScenarios.CLICKED_FORWARD_WITH_NON_SAFELITE_SHOP);
+        },
+        continueClaim() {
+            useMainStore().updateIsSafeliteProvider(true);
+            this.navigateWithScenario(navigationScenarios.CLICKED_FORWARD_WITH_SAFELITE);
+        }
     }
 };
 </script>