ERS Reimbursement

EMERGENCY ROAD SERVICE REFUND APPLICATION

Dear Member;

The following information is necessary in order to ensure prompt consideration for reimbursement in accordance with your membership benefits. Please complete form and attach original paid receipt.

Fill out the form w/original paid receipt within 60 days of service for consideration.

First Name*

Last Name*

AAA Membership Number

Exp Date

Street Address*

City*

Zip Code*

Phone Number*

Email*

Did you call AAA’s 24-hour Emergency Road Service number when breakdown occurred?*

Yes No

Date of Service

Time of call

Service Call Address

Service Call City

Service Call Zip

Type of service received*

Location of vehicle at time of breakdown

Was your vehicle towed?

Yes No

Make and Model of the vehicle

Year of the vehicle

Amount paid for Emergency Road Service

ATTACH ORIGINAL PAID RECEIPT

Select a file

Reason for charges

IF ACCIDENT ATTACH POLICE REPORT

Select a file

Driver of the vehicle at time of disablement

reCAPTCHA

Join AAA Today!

Trip Canvas

Members Save Big on Insurance

AAA Visa Signature® Credit Cards

Roadside Assistance

Save on Tickets!

How to Drive Online

ERS Reimbursement

EMERGENCY ROAD SERVICE REFUND APPLICATION