Safe Ride Reimbursement Form AAA Student members, fill out the information below, include your original taxi receipt, and mail within sixty (60) days of Safe Ride to: AAA MountainWest Attn: Member Services PO Box 4129 Helena, MT 59604-4129 Applications received more than 60 days after date of Safe Ride are not eligible for refund consideration. Membership Information Membership Number Expiration Date Mailing Address Name City State Email Address Cell Phone Other Phone Date of Safe Ride Time (am/pm) Zip Safe Ride Information Reason for Safe Ride Location of Pick Up Distance of Safe Ride Total Taxi Fare $ I verify that all information provided is accurate and true: Signature Date For More Information Contact: AAA MountainWest Attn: Member Services PO Box 4129 Helena, MT 59604-4129 1-800-222-2045 ● 406-447-8104 ● AAA.com/Student • Include original receipt. • Submit within 60 days of Safe Ride. • Please allow 30 days from date we receive this form to process your request. Safe Ride Reimbursement 2011 Revised 08.11 AAA Student Safe Ride Member Benefit Life is full of uncertainties and your day might not turn out exactly as planned. If you find yourself stranded or otherwise unable to get home, we will reimburse the cost of a taxi/cab ride. Limited to one Safe Ride per membership year, up to $25. This service is not intended to replace everyday transportation. This benefit is not counted toward your four allowable service calls. Request for reimbursement consideration must be received in writing by AAA MountainWest with the appropriate documentation within 60 days of the Safe Ride. Conditions for Reimbursement Reimbursement Procedure The following conditions must be met to be eligible for reimbursement consideration: Please follow these steps to apply for reimbursement: 1. Must be a Student member of AAA MountainWest in good standing. 2. Fill out the application on the other side of this sheet. 2. Only one cab ride per member, per membership year, will be eligible for reiumbursement. 3. Request for reimbursement must be received within 60 days of Safe Ride. Reimbursement will only be considered for Safe Rides occuring within AAA MountainWest coverage service area of Montana, Wyoming and Alaska. Reimbursement will not automatically equal $25 for Student members. The member will only be paid for cost of the taxi fare as shown on original receipt. Reimbursement amounts are subject to change at any time. Approved reimbursements will be paid by check, directly to the member. 1. Secure itemized receipt covering the cost of your cab ride. 3. Submit the application and original receipt within 60 days of the date of the Safe Ride to: AAA MountainWest Attn: Member Services PO Box 4129 Helena, MT 59604-4129 Safe Ride Limitations & Exclusions Safe Ride benefits do not cover: 1. Safe Rides occurring outside AAA MountainWest service area of Montana, Wyoming and Alaska. 2. Safe Rides used as everyday transportation; such as rides to and from work, the gym, school, etc. Safe Ride Reimbursement Form Our goal is to process your Safe Ride Reimbursement Form as quickly as possible. Please fully complete the application on the reverse, enclose your original receipts and return within 60 days of your Safe Ride. Your Member Handbook has detailed member benefit information. Review the most recent edition at AAA.com.
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