Important: We must have a signature to complete this transaction. Please do not return by e-mail.
Please keep a copy of this form for your records.
AAA
P.O. Box 25499
Santa Ana, CA 92799-5499
8451 03
14
EXPIRE
DATE
OR Fax: 714.850.8097
Please detach at line.
AUTHORIZATION AGREEMENT FOR MEMBERSHIP CREDIT OR DEBIT CARD PAYMENTS
AAA Auto Pay Plan
To use AAA Auto Pay for your membership, enter your Club Code and Membership Number as it appears on your membership card in the boxes below.
Unless the last 4 digits of your credit or debit card (previously provided to us) have already been filled in, please enter your complete account number
and card expiration date below.
Club Code First 8 Digits of Membership Number
MEMBER #
-
I hereby authorize AAA Hawai’i, LLC (“AAA”) to charge my CREDIT or DEBIT CARD ACCOUNT indicated below for all membership dues that become
due by me to AAA. All charges to my Credit or Debit account are governed by the Terms and Conditions that accompanied this Agreement.
Visa®
Discover®
MasterCard®
American Express®
CARD # /
This authorization is to remain in full force and effect until terminated by AAA or by me.
NAME OF ACCOUNT HOLDER DATE SIGNATURE OF ACCOUNT HOLDER
AAA Employee # (if applicable) Branch/Sec # Membership # Member Name
Membership AAA Auto Pay Plan
Credit or Debit Cards Terms and Conditions
At least one month before your AAA Hawai’i, LLC (“AAA”) membership expires, we’ll send a statement of your current services and renewal dues
amount. We will automatically renew your membership and charge the dues shown on your statement to your credit or debit card on file 10 to 15
days prior to your renewal date, unless you contact us to make a change to or cancel AAA Auto Pay. If we are unable to process the charge, we may
cancel your AAA Auto Pay enrollment and you will be contacted by mail and/or by phone and provided the opportunity to renew by mail or phone or
online at AAA.com or your local AAA branch. At that time, you may also re-enroll in the program with updated credit or debit card information.
If your VISA, MasterCard, or Discover credit or debit card issuing bank participates in the Card Account Updater program, we may receive an updated
credit or debit card account number and/or expiration date for the card information you have previously provided us, unless you Opt Out of the
service with your issuing bank. We will update our files and use the new information when we bill you under AAA Auto Pay. We won't receive
updated information if your account has been closed. Debit card available with VISA/Mastercard only.
You may update your account number and/or expiration date, change your membership options, or cancel AAA Auto Pay at any time by contacting
us at 1.808.593.2221 on O’ahu or 1.800.736.2886 on neighboring islands.
To have your membership dues automatically charged to your credit or debit card each year,
Complete and mail the form below using the envelope provided or return to:
M M Y Y
Would you like a fill-able form to complete for the Member/Insured
OR
Print a blank form for the Member/Insured?
