reimbursement application - aaa
TRANSCRIPT
Reimbursement Application
Please complete this application form fully. Please type or print legibly to expedite processing.
Member’s Name: Day Phone: E-Mail:
Mailing Address:
Membership Number: Expiration Date:
City: State: Zip Code:
Vehicle Year Make Model Color
Date of Service Time of Service Location of Service
City State What was the problem?
If AAA provided service, why were you charged?
If AAA was not contacted for service, please explain:
Select Save/Print and save the form to your computer or device. Open an email and attach a scanned copy of the receipt or any applicable documents to the email. Send to: [email protected]
To submit the application, fill out the form in full. Select the Email button above. Attach a scanned copy of the receipt or any applicable documents to the email and send.
OR
Please allow up to 4 weeks from the date of receipt for processing. Please keep a copy of this reimbursement form and the original battery service invoice for your records. Incomplete documents may delay processing. Please feel free to call the Member Relations Department at (412) 365-7699 with any questions.
Service Type
Items Not Reimbursed by AAA:
Tire Repair │ Storage │ Receipt Over 60 Days Old │ Receipt not in the Member’s Name │ Impound Fees │ Parts and Labor │ Towing of Stolen Vehicles │ Towing to Junkyards │ Towing a Vehicle Just Purchased │ Vehicles with Snow Plows
City State Miles Towed
Was service provided by a AAA service provider?
If towed, what was the destination?
Did you call AAA for Service?
Were you present when service arrived with a valid ID?