ROADSIDE ASSISTANCE CONTRACTOR APPLICATION
Name of company
Ownership structure
Business address
City
State
Zip
Name of owner (please include any partners or corporate officers
Email
Website
Telephone (Day)
Telephone (Night)
Telephone (24-Hr)
1. Do you provide 24-Hour service?
2. Have you ever held a AAA contract before?
3. Do you conduct background checks on your employees?
4. Do you conduct drug testing on your employees?
5. Are you contracted with Police, D.O.T. or County rotations?
6. Are you contracted with other motor clubs?
7. Do you provide salvage or repossession work?
8. How many years in business?
9. How many employees?
10. Do you have a repair facility?
Name of insurance carrier
Address
Agent
Phone
Please list coverage Amounts
A. Commercial Garage/General Liability
B. Commercial Auto Liability
C. Garage Keeper
D. On Hook/Cargo (Tow Only Providers)
E. Workers Compensation (where required)


1. We will discuss our requirements with you after your application has been reviewed.
2. Prior to any contractual agreement with AAA – The Auto Club Group, a certificate of insurance (COI) listing the club as certificate holder and listed as additional insured on General Liability.
In the event of a member’s complaint to AAA, will you cooperate fully in any investigation and decision of AAA?
Services you provide:
1. Locksmith
2. Light Service Only (tire changes, jump starts, lockouts, etc.)
3. Light Duty Towing (passenger vehicles)
4. Motorcycle Towing
5. Medium Duty Towing (10,001 to 26,000 lbs GVWR and with 6 tires or more)
6. Heavy Duty Towing (26,001 lbs or more GVWR and with 6 tires or more)
1. Locksmith
2. Light Service Only (tire changes, jump starts, lockouts, etc.)
3. Light Duty Towing (passenger vehicles)
4. Motorcycle Towing
5. Medium Duty Towing (10,001 to 26,000 lbs GVWR and with 6 tires or more)
6. Heavy Duty Towing (26,001 lbs or more GVWR and with 6 tires or more)
Units
Year
Make
Model
Units
Year
Make
Model
Units
Year
Make
Model
Units
Year
Make
Model
Units
Year
Make
Model
(Use separate sheet for additional equipment)
Coverage Area: List those cities/towns that you can maintain a 45-minute or less average arrival time.
Please list industry specific certifications and awards:
The undersigned hereby makes application for appointment as an official Roadside Assistance service contractor of AAA to render Roadside Assistance service to AAA Members and submits the information herein as being true and correct as a basis for consideration of this application.
If ACG wishes to move forward after reviewing this application, someone from our back office will reach out to you for the required information. In making this application for a Roadside Assistance service contract, it is understood that AAA may investigate, or have an outside agency investigate, the personal and business background of any individuals listed or found to be partners or officers of the firm desiring a contract and obtain information concerning retail credit history from credit reporting agencies and financial institutions. It is understood and agreed that the information discovered is confidential and may not be disclosed to the applicant.
Owner’s Signature
Date
Please ensure that your electronic signature is completed before submitting.
Submit

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