ca_vip_rebate_app_form

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					                    AUTOMOBILE CLUB OF SOUTHERN CALIFORNIA
                                          VEHICLE INSPECTION PROGRAM ( “VIP” )
                                                REBATE APPLICATION
   Please be aware of these eligibility requirements:
   1. A copy of the Inspection Report and a copy of the paid invoice provided by the Approved Auto Repair facility are
       required to process the VIP rebate application.
   2. The receipt AND Inspection Report must be made out to a valid AAA Premier member.
   3. The request must be postmarked or received within 60 days after the date of inspection.
   4. Limited to one VIP rebate per AAA Premier cardholder, per membership year.
   5. Maximum rebate amount is $45.00.
   Please follow these instructions:
   1. Please complete all sections to the signature line. Please type or print legibly to expedite processing.
   2. Keep a copy of this form, the original Inspection Report and the original paid invoice for your records.
   3. Attach this form to the copies and mail them to the Auto Club at this address: AAA Club Services, LLC
      Attn: ERS A-321, PO Box 25001, Santa Ana, CA 92799-5001.



Member’s Name:                                                                                               Day Phone: (                 )              -

Mailing Address:
City:                                                                                          State:                                         Zip:

Club Code:                   004                 Membership #:                                                                     Exp. Date:

Name of repair                                                                           Date of
facility:                                                                                Service:                                        Fee: $

Vehicle Year:                                   Make:                                                       Model:

Inspection Fee:            $

Member’s Signature:                                                                                                  Date:

Dear Member: Thank you for your submittal. Be assured that your request will be processed as quickly as possible. You should receive a response within 10 working days
after your request has been received. If not, please feel free to call ERS Administration toll-free at (888) 222-9441.

VIP Rebate Benefits: AAA Premier members are entitled to a rebate of $45.00 off the current price of the Vehicle Inspection Program service. This rebate is limited to one (1)
per AAA Premier cardholder, per membership year. The vehicle inspection must be performed at a participating Approved Auto Repair facility that currently offers this
service. The AAA Premier member must submit a rebate form, a copy of the Inspection report and a copy of the paid invoice provided by the Approved Auto Repair facility to
the Auto Club within 60 days after the date of inspection for the rebate of $45.00.




   FOR OFFICE USE ONLY –

   _____ (RF H)           VIP rebate for AAA Premier Individual member--------------793/711

   _____ (RF I )          VIP rebate for AAA Premier Family member -----------------794/711


Receipt Amount: $                                         Covered Amount: $                                                 Amount Rebated:          $

Authorized Signature:                                                                        Date:


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