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Please ensure you attach a copy of the original receipt(s) at the bottom of this form within 60 days of the roadside assistance or locksmith event. We kindly ask that you allow up to 30 days for processing your request.
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‌Reimbursement is based on your membership level and coverage at the time of service. You can view the member benefits guide here.‌

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First Name

Last Name

Membership Number (16 digit - begins with 438212)

Address

City

State

Zip Code

Phone Number

Was AAA Contacted?

NoYes

Were the Police Involved?

NoYes

Why was AAA service not used?

Service Date

Vehicle Year

Vehicle Make

Vehicle Model

Cause of Breakdown

Vehicle Type

Type of service provided

Premier Members Only

Service Facility Name

Breakdown Location Address, City, State

Location vehicle was towed Address, City, State

Number of Miles Towed (numeric characters only)

Was the vehicle towed from an accident?

NoYes

If Yes, your Insurance Declaration Page MUST be included with your other attachments for your reimbursement to be processed.

Amount Requested (numeric characters only)

Please attach receipt(s) at the bottom of this form (required)

When attaching multiple files click and hold the “CTRL” button. Please remove any sensitive information such as credit card numbers, banking information, Social Security Numbers, birthdays, etc.

Attach a file

Our Club is just one in over 40 AAA/CAA Clubs in the Federation- all ranked according to ERS Performance. Quality meetings bring our Management teams together to review and respond to our current performance environment and plan for the future.