Aaa Roadside Assistance Nc Form PDF Details

It's always a good idea to have Aaa roadside assistance Nc form just in case you find yourself in a roadside emergency. This form will provide all the necessary information for Aaa to help you get back on the road as quickly as possible. In addition, having this form on hand will help ensure that there is no misunderstanding between you and the Aaa representative. So, don't wait-download your copy of the Aaa roadside assistance Nc form today!

Form NameAaa Roadside Assistance Nc Form
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesJumpstart, applying aaaaa, Exp, AAAs

Form Preview Example

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


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

Lock-out Tow Other

Please explain how you acquired assistance: Called AAA Office

Passing motorist called garage

Located nearest garage on your own

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 No

Were you present when the service driver arrived? Yes


Did you provide a valid AAA Mmembership card to the service driver? Yes No

Was your vehicle involved in an accident? Yes No

(If “Yes,” please attach copy of police report.)

Was your vehicle towed? Yes No


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.

Additional comments: ________________________________________________________________________________




Date _____________________ Member’s Signature ______________________________________________________

MB-158701-18 (12/18)

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As a way to complete this PDF document, be sure to type in the necessary details in each and every blank:

1. To start off, when filling out the Jumpstart, start with the area with the next blanks:

Simple tips to fill in AAAs portion 1

2. The subsequent step is usually to submit all of the following fields: Were you present when the service, Yes, Did you provide a valid AAA, Yes, Was your vehicle involved in an, No If Yes please attach copy of, Was your vehicle towed, Yes, If Yes where was it towed From to , Approximate mileage vehicle was, Amount paid for Emergency Roadside, Please attach original paid, Note If your vehicle was involved, please submit your bill to the, and Additional comments .

Tips on how to complete AAAs step 2

A lot of people generally get some things wrong while filling in Note If your vehicle was involved in this section. Be certain to re-examine everything you type in here.

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