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Suzuki Secure Advantage Roadside Assistance Customer Claim Form
Complete this form when claiming reimbursement for Roadside Assistance or Emergency Travel Expense
important:
Please refer to the Warranty & Maintenance Information booklet for coverage details. Submit all claims, fully docu-
mented, within
20 days of disablement.
Please retain a copy of all receipts and
send original documentation.
Please include
original paid receipts
, validated by the service establishment, which
clearly detail
the nature of the service provided.
Way of Life!
1. your Suzuki Secure Membership number is your
vehicle identification number
2. owner information
3. roadside Assistance Claim
4. emergency Travel expense Claim (maximum $300)
Meals:
$
Accomodation:
$
Commercial Transportation:
$
(enter the 17 digit vehicle identification number - VIN)
You must include the following documents: Paid receipts for reasonable covered expenses incurred within 3 days of disablement. For disablement due
to collision, a copy of the Accident Report which was filed with the appropriate police authority.
Road Service: $
Towing: $
(maximum $100)
(maximum $75)
First Name
Last Name
Prov
Postal Code
Residence Phone
Business Phone
Extension
Street
Apt
City
Rental Vehicle:
$
Other: (Please Specify)
$
Detailed Description:
