AAA Roadside Assistance NC Form PDF Details

The AAA Roadside Assistance NC form is a reimbursement document that North Carolina AAA members use to recover costs for roadside help paid out of pocket. Covered services include towing, battery jump-start, flat tire change, fuel delivery, and lockout assistance. To be eligible for reimbursement, you must submit this document to AAA Carolinas within 60 days of the service date.

To complete the form, you will need your AAA membership number, the service date and location, and details about the type of roadside assistance received. The form asks whether you were present when the service was performed, whether your vehicle was towed, and the distance and destination if towing occurred. It also asks whether you called AAA's 24-hour hotline before seeking outside help and whether your vehicle was involved in an accident.

Required attachments include the original paid receipt from the roadside service provider. If your vehicle was involved in an accident, include a copy of the police report as well. Reimbursement amounts are subject to your AAA membership plan's benefit limits. Double-check all fields for accuracy and keep copies of your documents before mailing the form to AAA Carolinas. Most claims are reviewed within four to six weeks of receipt.

QuestionAnswer
Form NameAAA Roadside Assistance NC Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesAAA Roadside Reimbursement Form, AAA NC Emergency Road Service Form
StateNorth Carolina
AgencyAAA Carolinas
Form TypeReimbursement Request
Submission DeadlineWithin 60 days of service

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

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

฀ 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

฀ No

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)

How to Edit Aaa Roadside Assistance Nc Form Online for Free

Handling PDF forms online is simple with FormsPal's editor. To complete the AAA Roadside Assistance NC form, open it with the "Get Form" button, fill in all required fields including your membership number and service details, attach your original receipt, then download or submit the finished form to AAA Carolinas.

Step 1: Click the "Get Form" button at the top of this page to open the AAA Roadside Assistance NC form in the online editor. All the fields you need to complete your reimbursement request will be ready to fill in.

AAA Roadside Assistance NC form fill out step 1

Step 2: Complete each section of the AAA Roadside Assistance NC form. Enter your AAA membership number, name, address, and phone number. Provide the roadside service date, location, and the type of assistance you received. Indicate whether you were present at the scene and whether your vehicle was towed or was in an accident.

AAA Roadside Assistance NC form complete required fields step 2

Step 3: Review all entries for accuracy, then click "Done." You can download the completed AAA Roadside Assistance NC form or email it directly. Creating a free 7-day account lets you save and send the form right away without any software to install.

Frequently Asked Questions About the AAA Roadside Assistance NC Form

What roadside services does the AAA Roadside Assistance NC form cover?

The form supports reimbursement for towing, battery jump-start, flat tire change, fuel delivery, and lockout assistance for North Carolina AAA members.

How long do I have to submit the form?

North Carolina AAA members must submit the completed form to AAA Carolinas within 60 days of the roadside service date. Claims received after 60 days will not be accepted for reimbursement.

What documents should I attach to the AAA Roadside Assistance NC form?

Attach the original paid receipt from your roadside service provider. If your vehicle was involved in an accident during the incident, also include a copy of the police report.

Where can I find other AAA or vehicle-related forms?

FormsPal also provides the AAA Form AR and the AAA Property Loss Worksheet. For vehicle paperwork, try the Authorization to Repair Vehicle form or the Automobile Insurance Application.

Aaa Roadside Assistance Nc Form isn’t the one you’re looking for?

Related Documents