Roadside Assistance Claim Submissions

Roadside Assistance Claim Submission

Please complete the below form to submit your reimbursement claim. If you have any questions or additional information, please contact CustomerService@vatire.com.

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Your Information

First Name*

Last Name*

Phone*

Email*

Mailing Address*

VTA Service Information

Vehicle Year, Make and Model*

Date of Vehicle's Most Recent VTA Service*

Location of Vehicle's Most Recent VTA Service*

VTA Service Invoice Number*

Roadside Assistance Provider Information

Roadside Assistance Provider Name*

Date of Roadside Assistance*

Roadside Assistance Service Invoice Number*

Requested Reimbursement Amount*

Note: Reimbursement claims are limited to $100 per occurrence. For more information, visit https://vatire.com/anytime-roadside-assistance/

Upload Roadside Assistance Receipt/Invoice*

Accepted file types: jpg, png, pdf, Max. file size: 2 GB.

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