Get AAA Carolinas Application for Refund of Roadside Assistance Service Expenses 2018-2024

Return completed form to AAA Carolinas P. O. Box 29600 Charlotte NC 28229 Attn Member Relations Dept. Questions Call us at 1-877-282-3682 APPLICATION FOR REFUND OF ROADSIDE ASSISTANCE SERVICE EXPENSES Requests must be submitted within 60 days from date of service. Return completed form to AAA Carolinas P. O. Box 29600 Charlotte NC 28229 Attn Member Relations Dept. Questions Call us at 1-877-282-3682 APPLICATION FOR REFUND OF ROADSIDE ASSISTANCE SERVICE EXPENSES Requests must be submitted within 60 days from date of service. Please complete entire form or refund may be delayed* Member s Name Address City State Zip Telephone Home Work Cell E-mail Address AAA Membership Number Exp* Date Date Service was Rendered Time Type of Vehicle Make Model Year Location of Disablement Nature of Trouble Jumpstart Battery Tire Change Gas Please explain how you acquired assistance Called AAA Office Located nearest garage on your own Lock-out Tow Other Passing motorist called garage Called AAA garage direct Police called nearest garage If AAA s 24-hour toll-free hotline was not called please explain why Were you driving or riding in the vehicle when it broke down Yes Were you present when the service driver arrived Yes No Did you provide a valid AAA Ma membership card to the service driver Yes Was your vehicle involved in an accident Yes If Yes please attach copy of police report. If Yes where was it towed From to Approximate mileage vehicle was towed Amount paid for Emergency Roadside Assistance only Please attach original paid receipt and retain a copy for your own records. Note If your vehicle was involved in an accident and collision insurance was in force please submit your bill to the insurance company for reimbursement. Questions Call us at 1-877-282-3682 APPLICATION FOR REFUND OF ROADSIDE ASSISTANCE SERVICE EXPENSES Requests must be submitted within 60 days from date of service. Please complete entire form or refund may be delayed* Member s Name Address City State Zip Telephone Home Work Cell E-mail Address AAA Membership Number Exp* Date Date Service was Rendered Time Type of Vehicle Make Model Year Location of Disablement Nature of Trouble Jumpstart Battery Tire Change Gas Please explain how you acquired assistance Called AAA Office Located nearest garage on your own Lock-out Tow Other Passing motorist called garage Called AAA garage direct Police called nearest garage If AAA s 24-hour toll-free hotline was not called please explain why Were you driving or riding in the vehicle when it broke down Yes Were you present when the service driver arrived Yes No Did you provide a valid AAA Ma membership card to the service driver Yes Was your vehicle involved in an accident Yes If Yes please attach copy of police report. Please complete entire form or refund may be delayed* Member s Name Address City State Zip Telephone Home Work Cell E-mail Address AAA Membership Number Exp* Date Date Service was Rendered Time Type of Vehicle Make Model Year Location of Disablement Nature of Trouble Jumpstart Battery Tire Change Gas Please explain how you acquired assistance Called AAA Office Located nearest garage on your own Lock-out Tow Other Passing motorist called garage Called AAA garage direct Police called nearest garage If AAA s 24-hour toll-free hotline was not called please explain why Were you driving or riding in the vehicle when it broke down Yes Were you present when the service driver arrived Yes No Did you provide a valid AAA Ma membership card to the service driver Yes Was your vehicle involved in an accident Yes If Yes please attach copy of police report. If Yes where was it towed From to Approximate mileage vehicle was towed Amount paid for Emergency Roadside Assistance only Please attach original paid receipt and retain a copy for your own records. .