REIMBURSEMENT FORM

This form allows AAA Members to request reimbursement for eligible Roadside Assistance or locksmith services that were paid out of pocket. Reimbursement is based on your Membership level and coverage at the time of service.

You can view the Member benefits here.

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.

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Member Information

Membership Number (16 digits - begins with 438212) *

First Name *

Last Name *

Best Contact Number *

Email *

Home Address

Street Address *

Apt, Suite, etc. (optional)

City *

State *

ZIP Code *

Please send reimbursement to a different mailing address.

Vehicle Information

Vehicle Year *

Vehicle Make *

Vehicle Model *

Service Information

Service Provider Name *

Service Date *

Was AAA contacted prior to engaging this provider? *

Why was the AAA service provider not used? *

Reimbursement amount requested *

Location of Service *

Street

City *

State *

Zipcode

Cause of the incident *

Please describe the cause of the Incident

Were the police involved? *

Towing Information

Was the vehicle towed? *

Attachments and Receipts

Upload Files *

Click to upload filesJPG, JPEG, PNG, PDF (UP TO 5 files, max total combined size: 4MB)