Automotive and Home Reimbursement Consideration Form

Complete the form below and attach the itemized receipt(s).

AAA Members are eligible for locksmith services depending on Membership level.

AAA Classic
Up to $50 (Locksmith car only)
AAA Plus or Plus RV
Up to $100 (locksmith car only)
AAA Premier
Up to $150 (locksmith for car or residence)
Up to $50 (repair or replacement of car windshield*)

*Premier Members are eligible for a one-time $50 reimbursement for the repair or replacement of a car windshield per Membership year.

For accident related tows not reimbursed through insurance, your signed statement or a statement from your claims adjuster is required. All vehicles to be serviced must be registered for highway or street use to be eligible for services.

Reimbursements must be submitted within 60 days from the date of service.

Type of Disablement:

Breakdown

Accident

Lockout

Windshield

Date of Service

Membership #

Member First Name

Member Last Name

Member Mailing Address

Apt #

City

State

ZIP Code

Member Phone Number

Member Email

Requested Reimbursement Amount

Detailed Summary of Request

Date of Disablement

Full Name

Type your full name here to serve as your signature that what you are submitting is true to the best of your knowledge.

Supporting Documents