Premier RV Car Rental
Reimbursement Request Form
REV081514
MEMBER INFORMATION
DateofAAARoadsideAssistancewhenvehiclewastowed(mm/dd/yyyy):
Date(s)ofcarrental(mm/dd/yyyy): to
Amountpaidforrentalcar:
Rentalcarprovider: Phone:
Additionalcomments:
CAR RENTAL INFORMATION
IunderstandthatthePremierRVCarRentalreimbursementwillbepaidwithinspeciclimitationslisted
inthecurrentMemberHandbookforthisbenet.Thereimbursementwillbebasedontheitemized
paidreceiptsenclosed.Ialsoagreethatallthedocumentationsubmittedforthisreimbursement
reviewreectsarentalthatbeganwithintwodaysoftheroadsideassistanceandanyrentalthatbegan
beyondthatpointisnotreimbursable.
Signature: Today’sdate:
Note: Please make a copy of this form and all attachments for your records. Requests that are not
completed or accompanied with the original receipt(s), or photocopies of the original receipt(s), may be
returned. Mail signed claim form and receipts to:
AAA – Premier RV Car Rental Reimbursements, 4010 South 148th Street, Omaha, NE 68137
Please allow two weeks to process your request. Inquiries regarding your reimbursement request may
be made by calling 866-255-6757 during regular business hours.
YourPremierRVMembershipincludesreimbursementoneligibleone-daycarrentals
relatedtoanon-collisionroadsideassistancetowevent.
VisitAAA.com/MemberHandbookforcompletedetails.
PremierRVMembership#(16digit):
Name:
Address:
City: State: Zipcode:
Contactnumbers:Home: Cell:
Email:
IMPORTANT:Anycorrespondenceinregardstoyourreimbursementconsiderationrequestwillbesenttotheaddressyouprovide
onthisform.Tochangeyouraddressonourmembershiprecords,pleasegotoAAA.com orcontactyourlocalAAAofce.
FORPROCESSINGONLY
Approved?:
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Code:
Amount:
Processorinitials:
Processdate: