Triple A Reimbursement Form 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?Yes
Fillable fields41
Avg. time to fill out8 min 46 sec
Other namesaaa reimbursement, aaa receipt, aaa reimbursement form pdf, reimbursement 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

You can complete the aaa roadservice form document with our PDF editor. The following steps will let you quickly get your document ready.

Step 1: The following webpage includes an orange button that says "Get Form Now". Click it.

Step 2: So you're on the document editing page. You can change and add information to the file, highlight words and phrases, cross or check certain words, insert images, insert a signature on it, delete unwanted areas, or remove them completely.

Prepare the particular sections to prepare the template:

aaa tow reimbursement fields to complete

Provide the requested details in the space Who was called, Vehicle make:, Vehicle year: Breakdown location, Vehicle model:, State:, and Amount paid for service: $.

Entering details in aaa tow reimbursement stage 2

The system will ask you for information to automatically fill out the box Signature: Note: Please make a, Today’s date:, or accompanied with the original, AAA – Road Service Reimbursement, Inquiries regarding your, and REV081514.

Signature: Note: Please make a, Today’s date:, or accompanied with the original, AAA – Road Service Reimbursement, Inquiries regarding your, and REV081514 in aaa tow reimbursement

Step 3: Choose "Done". It's now possible to export the PDF file.

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