Aaa Service Reimbursement Form PDF Details

service reimbursement forms. The form can be used to request reimbursement for services you have provided to a client. The form must be completed and submitted within 60 days of the service date. The Aaa Service Reimbursement Form is used to request reimbursement for expenses associated with providing service to a client. This includes, but is not limited to, transportation costs, hotel costs, and meal expenses. The form must be completed and submitted within 60 days of the service date.

You will find information about the type of form you want to fill out in the table. It will tell you how much time you will require to complete aaa service reimbursement form, what parts you need to fill in and several other specific details.

QuestionAnswer
Form NameAaa Service Reimbursement Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesaaa northeast reimbursement form, aaa reimbursement form pdf, triple a reimbursement, how to get reimbursed from aaa

Form Preview Example

Road Service

Reimbursement Request

Payment Limitation

If you obtain non-AAA Roadside Assistance without irst requesting service from AAA, your reimbursement will be up to the contract rate paid to AAA service providers for similar services.

NOTE: In all cases, reimbursement coverage is limited to road service detailed in your membership handbook (visit AAA.com/MemberHandbook) up to the maximum entitlement allotted by your membership.

Reimbursement does not include vehicle repair, tire repair, labor, battery charges or storage.

Submission Instructions

Reimbursement applications must:

Include an original itemized paid receipt from a service provider

Be attached to a fully completed Road Service Reimbursement form

Be submitted within the deined time period as detailed in the member handbook to be considered

Please allow two weeks to process your request. Submit the application and original receipts to:

AAA– Road Service Reimbursement, 4010 S. 148th St., Omaha, NE 68137

Inquiries regarding your reimbursement request may be made by calling 866-255-6757.

REV081514

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Road Service

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reimbursement Request

 

 

 

 

 

 

 

 

 

Please ill out this form completely and print legibly

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MEMBER INFORMATION

 

 

 

 

 

Membership number (16 digit):

 

 

 

 

 

 

 

 

FOR PROCESSING ONLY

Name:

 

 

 

 

 

 

 

 

 

 

Approved?: Yes NO

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

Code:

 

 

City:

 

 

 

 

 

 

 

 

 

State:

 

 

Zip code:

 

Amount:

 

 

Contact numbers: Home:

 

 

 

 

Cell:

 

 

 

Processor initials:

Email:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Process date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IMPORTANT: Any correspondence in regards to your reimbursement consideration request will be sent to the address you provide

on this form. To change your address on our membership records, please go to AAA.COM or contact your local AAA ofice.

ROAD SERVICE INFORMATION

Facility name:

 

Date of service (mm.dd. yyyy):

Time of service

 

 

 

 

 

 

 

 

 

Type of problem: (check appropriate box)

 

 

 Flat tire

OUT OF FUEL

 Lockout/key made

 Accident/police call

Jump-start

TOW

 Winch/stuck

 Motorcycle coverage

WHO WAS CALLED?

 

 

 

 

 

 AAA local ofice

 AAA toll-free

 Called facility direct

DID NOT CALL AAA

Reason AAA service was not used?

Additional comments:

Vehicle year:

 

Vehicle make:

 

 

Vehicle model:

 

 

 

 

 

 

 

 

 

 

 

 

 

Breakdown location (address, cross streets or reference points):

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

State:

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE TOWED TO (street, city, state):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Miles towed:

 

 

 

 

Amount paid for service: $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If AAA service is available and not used, reimbursement will be limited to what it would have cost AAA to provide the covered service.

Signature:

 

Today’s date:

NOTE: Please make a copy of this form and all attachments for your records. Applications that are not completed

or accompanied with the original receipt(s) may be returned. Submit the application and original receipts to:

AAA – Road Service Reimbursement, 4010 S. 148th St., Omaha, NE 68137

Inquiries regarding your reimbursement request may be made by calling 866-255-6757. REV081514

How to Edit Aaa Service Reimbursement Form Online for Free

Our PDF editor was made to be as simple as it can be. If you stick to the following actions, the procedure for creating the aaa tow reimbursement form will be stress-free.

Step 1: Choose the button "Get Form Here" on the webpage and select it.

Step 2: As soon as you've entered the editing page aaa tow reimbursement, you'll be able to notice all the actions available for the document at the upper menu.

If you want to create the aaa tow reimbursement PDF, enter the information for all of the sections:

stage 1 to filling out aaa northeast reimbursement form

In the Please ill out this form, Membership number digit Name, State, Cell, Zip code, FOR PROCESSING ONLY Approved Yes, IMPORTANT Any correspondence in, ROAD SERVICE INFORMATION, Facility name, Flat tire Jumpstart, Date of service mmdd yyyy Type of, Out of fuel Tow, Time of service, Accidentpolice call Motorcycle, and Who was called AAA local ofice field, note down the information you have.

aaa northeast reimbursement form Please ill out this form, Membership number  digit Name, State, Cell, Zip code, FOR PROCESSING ONLY Approved  Yes, IMPORTANT Any correspondence in, ROAD SERVICE INFORMATION, Facility name, Flat tire  Jumpstart, Date of service mmdd yyyy Type of, Out of fuel  Tow, Time of service, Accidentpolice call  Motorcycle, and Who was called  AAA local ofice blanks to fill

In the Additional comments, Vehicle year Breakdown location, Vehicle make, City Vehicle towed to street city, Vehicle model, State, Miles towed If AAA service is, Amount paid for service, Signature, Todays date, Note Please make a copy of this, AAA Road Service Reimbursement S, and REV box, focus on the necessary details.

Filling in aaa northeast reimbursement form step 3

Step 3: When you pick the Done button, your completed file is readily exportable to every of your devices. Or, you might deliver it by using mail.

Step 4: Generate duplicates of the file - it may help you keep clear of future troubles. And don't get worried - we are not meant to publish or read the information you have.

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