Motor club registration permaplate

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Membership Number

SafeRide Motor Club, Inc.

Deluxe Plan

Motor Club Registration

This is not an Automobile Liability Insurance Contract.

Member Name:

Home Phone:


Covered Vehicle Info:



Business Phone: City: VIN#

Email Address:



Odometer Mileage:

Membership Plan Information

Membership Plan Price* $__________________ * Membership Plan Price may be paid on your behalf by agency.

Plan Effective Date:___________ (MM/DD/YYYY) Plan Term Month(s): _______________________

Standard Vehicle Type Luxury Vehicle Type

I/We have read this Membership document in its entirety and fully understand its content and acknowledge receipt of a copy thereof. I further understand that this Membership is not required in order to obtain insurance for my vehicle and that my acceptance of the benefits under this Membership is voluntary.

I accept this Membership: (print names) Member Signature:


Member Signature:


Agency Number/Name:

Agent Signature:*


* Agent agrees and certifies that the registered vehicle, listed above, is eligible for the membership plan.

The term of this Motor Club Membership is effective from the date of sale, the Plan Effective Date, and continues for the number of months indicated in the Plan Term section above. If no term is selected, this membership will, by default, be assigned a term of one (1) month from the Plan Effective Date. Benefits are available for the covered vehicle listed above. Services are available throughout the United States, Mexico, and Canada. As a Member of this SafeRide Motor Club Program all benefits are available to the Member up to your specific benefit limits without additional payments. You are responsible for any expenses over the per occurrence limits or for any non-covered expenses. Your Membership begins on the Plan Effective Date shown on this Membership Registration page and will continue until the expiration date specified on the Membership Registration page, unless canceled in writing. You will not be required to pay any sum in addition to the membership fee and the amounts specified in this registration form for the services promised.

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DELUXE PLAN - EMERGENCY ROADSIDE ASSISTANCE Emergency Roadside Assistance is available on a Sign & Drive basis throughout the United States, Mexico, and Canada, 24-hours a day, 365 days a year. For prompt service, simply call the appropriate number listed below for any of these benefits: Towing, Jump Starts, Tire Changes (with your inflated spare), Vehicle Fluid Delivery (cost of fluids extra), Lockout Assistance (cost of key cutting/replacement extra), Concierge Service (emergency phone call support & assistance). Sign & Drive provided benefits mean you incur no out-of-pocket expense, up to a maximum benefit of $100 per incident, at a maximum of three (3) uses per twelve (12) months. Service fees exceeding this maximum benefit are the responsibility of the Member. Only service requests provided through the phone numbers below will be honored. Services are not available in areas where state providers are exclusively utilized. For service in the U. S. and Canada call 1-888-664-4561 (toll free), In Mexico call 01-800-232-6454, Locally in Mexico City call 5377-3892.

Key Recovery/Replacement Definitions Member, Customer, or You means the named person(s) to which this contract was issued. We, Company means the SafeRide Motor Club and its affiliates administering these services. Covered Repair Cost means the customary parts and labor costs required to complete the repair or replacement of the covered key/remote, which in no case shall exceed the manufacturer's suggested retail for a replacement key/remote. We reserve the right to use like kind and quality replacements for lost or damaged keys/remotes. Covered Key/Remote means one of the keys/remotes provided to you at the time of vehicle's original delivery.

Key Replacement Benefit In the event a covered vehicle key is lost, stolen, or destroyed, you are eligible for reimbursement from the company for one (1) replacement key and remote (if remote is also lost, stolen or destroyed) up to, but not to exceed, $500.00 for Standard Type Vehicles. For Luxury Vehicles Types the benefit is not to exceed $800. During the term of this contract there is a maximum of (1) one use per any given twelve (12) months. Prior authorization is required for key replacement. Key Replacement Exclusions:

1. Any replacement key made without the Plan Administrator's prior authorization. 2. Any cost or key replacement for which the manufacturer has announced its responsibility through any means, including public

recalls or factory service bulletins. 3. Any replacement cost covered by a repairer's/supplier's guarantee or warranty. 4. Any key replacement for a vehicle not listed on the registration page of this membership. 5. Any consequential damages or loss, whether direct or otherwise, resulting from the failure or loss of a covered vehicle key. 6. Any key replacement occurring outside the United States or Canada. Key Replacement Claims Procedure: Call 1-888-664-4561 (toll free) for prior authorization (by dealer or customer) and to initiate the claims process. If you are within 50 miles of original selling dealership please return to dealer for key/remote replacement process. 1. Customer or original dealer must pay for key/remote replacement at a servicing dealership or qualified key replacement facility. 2. Secure paid invoice with pre-printed facility information and mail to the address below. 3. Mail invoice and copy of your motor club registration page within 30 days of incident to:

Key Replacement, 13901 Midway Road, Suite 102-429, Dallas, TX 75244-4388. Emergency Replacement - If a key must be replaced when our claims office is closed and prior authorization for the replacement cannot be obtained the Member should proceed with the claim procedure listed above and contact us for reimbursement consideration instructions on the next business day.

24-Hour Home Lock-Out Assistance If YOU are locked out of YOUR home, WE will provide services to unlock YOUR home. Home lock-out assistance is covered at no expense to YOU up to a maximum limit of $100.00 per occurrence. If KEYS have to be made for YOUR home, WE will provide up to three (3) key replacements for the term of YOUR MEMBERSHIP. YOU must demonstrate proof of residence, such as a valid driver's license with the address indicated, and be present at the residence for home lock-out service.

CUSTOM DOMESTIC TRIP ROUTING SERVICE SafeRide Motor Club will, upon request, furnish Members with information, maps, trip itineraries, and SafeRide Motor Club discounted hotel reservations and discounted automobile rental services. Ten (10) business days advance notice required for customized Trip Routing. Call 1-888664-4561 (toll free).

TAXI, Loaner/Rental Assistance When YOUR Registered Vehicle's Keys are damaged and inoperable, lost or stolen, of locked in the registered vehicle, 24-hour assistance will be provided to assist YOU in obtaining a taxi or a rental vehicle in the event that replacement KEYS cannot be made at the disablement location. ? Taxi Assistance - When requested, a taxi will be dispatch to YOUR location and YOU will be reimbursed for up to $50.00 towards the cost of the taxi service. YOU are allowed one (1) reimbursement per occurrence. ? Loaner/Rental Vehicle Assistance - When requested, assistance will be provided to obtain a loaner vehicle for YOU from a qualified, national and licensed rental agency at discounted MEMBER rates. YOU will be reimbursed up to $50.00 towards the cost of the rental. YOU are allowed one (1) reimbursement per occurrence.

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HOTEL DISCOUNTS Members take advantage of savings when making reservations at the following hotels across the country:

Company AmeriHost Knights Inn Travelodge

Microtel Baymont Inn

Hawthorn Comfort Inn

Quality Clarion EconoLodge

Toll-Free # 1-800-434-5800 1-800-843-5644 1-800-578-7878 1-800-771-7171 1877-229-6668 1-800-527-1133 1-800-4-CHOICE 1-800-4-CHOICE 1-800-4-CHOICE 1-800-4-CHOICE

Discount ID # 1000007012 1000007012 1000007012 1000007012 1000007012 1000007012

00712101 00712101 00712101 00712101

Company Days Inn Howard Johnson Ramada Super 8 Motels Wingate Inns Comfort Suites Sleep Inn Mainstay Suites Roadway

Toll-Free # 1-800-329-7466 1-800-446-4656 1-800-272-6232 1-800-800-8000 1-800-228-1000 1-800-4-CHOICE 1-800-4-CHOICE 1-800-4-CHOICE 1-800-4-CHOICE

*Discount codes for hotel, rent-a-car, and entertainment are subject to change. Contact Customer Service for assistance.

RENT-A-CAR DISCOUNTS Members are eligible to receive savings when renting vehicles from the following national rental car companies:


Toll-Free #

Discount I.D. #


Toll-Free #






Budget Rent-A-Car



Hertz Rent-A-Car


Discount ID # 1000007012 1000007012 1000007012 1000007012 1000007012

00712101 00712101 00712101 00712101

Discount I.D. # SB00001

Online PIN: ENT 1844856

Entertainment Benefits SafeRide Motor Club provides each member with access to entertainment discounts through our corporate benefits site. Go to . benefits.aspx Review the program benefits, follow the link to sign-up. Your SafeRide Membership Code is VAS972. Benefits are provided by and the obligation of Plumb Benefits. DELUXE Plan: To utilize listed SafeRide Motor Club benefits Member must call the dedicated phone number. Please reference the appropriate feature and call the designated toll-free number for immediate service. Member must use the respective SafeRide Motor Club toll-free number to procure benefits under the Membership. Services secured independently of these toll-free numbers are not covered and may not be reimbursed. In the rare event that service is not obtainable by the SafeRide Motor Club, Member will receive a refund of payments made, according to the coverage limits outlined in the Membership. SafeRide Motor Club must be contacted for consideration of any independent service.

Arbitration In the event the Member and SafeRide Motor Club disagree on the amount of a covered loss or whether coverage is provided for under this Membership, each party may agree to submit the dispute to voluntary and non-binding arbitration. Each party further agrees to share equally in the cost of arbitration and either party may demand a three-member-arbitration panel.

Cancellation and Transfer This SafeRide Motor Club Membership may be cancelled by the SafeRide Motor Club upon mailing the named Member at the address of record, a written notice stating the time, not less than ten (10) business days thereafter, that such cancellation shall be effective based on:

A) Failure to pay a Membership fee when due or on grounds stated in this Membership. B) Material misrepresentation. C) Substantial breaches of contractual duties, conditions, or warranties. D) Substantial change in the task assumed, except to the extent that SafeRide Motor Club should reasonably have foreseen the change

or contemplated the risk in writing this Membership. The named Member may cancel the SafeRide Motor Club Membership by surrender hereof or by mailing to SafeRide Motor Club address below a written notice signed by the Member. The member will receive a pro-rata refund of their Membership fees calculated on a monthly basis without any deductions. This Membership may be transferred to another vehicle for a thirty dollar ($30) fee with a thirty (30) day transfer waiting period. The Member must call 1-888-664-4561 (toll free) for this purpose to obtain a transfer form. In Utah, cancellation for failure to pay your membership dues or during the first sixty (60) days shall be effective ten (10) days after delivery or firstclass mailing of a written notice to the member. For all other reasons, cancellation is effective thirty (30) days after the delivery of first-class mailing of a written notice to the member. First-class mailing means that delivery is assumed to occur three days after the notice is mailed. If a notice of cancellation or non-renewal does not state with reasonable precision the facts on which our decision is based, you have the legal right to make a written inquiry regarding the reason for the cancellation or non-renewal. We shall send by first-class mail or deliver that information within ten (10) working days after receipt of a written request by the member. Your benefits will end on the date you are no longer a member in accordance with the time frames above. Such termination will not affect your right to payment for a claim arising before the date of termination. In Wisconsin, a notice of cancellation or non-renewal shall state with reasonable precision the facts on which our decision to cancel or non-renew is based.

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Customer Service, OBLIGATIONS, and Contact information All Motor Club benefits are offered through SafeRide Motor Club, Inc. 1-888-664-4561 (toll free). The benefits and obligations under this Motor Club are backed by insurance. You have the right to file a complaint by submitting a written complaint to our Customer Care Department at 13901 Midway Road, Suite 102-429, Dallas, TX 75244-4388. or by contacting a representative at 1-888-664-4561 (toll-free). Benefits are available throughout the United States of America, Canada, and Mexico.

WISCONSIN RESIDENTS ONLY Under Wisconsin law, your Membership contract is considered an insurance policy. Further, after the first sixty (60) days and prior to the expiration of the agreed term (or one year from the effective date of Membership, whichever occurs first) your Membership may not be canceled by us except: 1) for failure to pay the Membership fee; 2) in the event of material misrepresentation by you; 3) in the event of a substantial change in the risk assumed reasonably unforeseen by us; or 4) for a breach of contractual duties, conditions or warranties by you. No cancellation will become effective until at least ten (10) days after the first-class mailing or delivery of a written notice to you. Additionally, you have the right, subject to the cancellation provisions above, to have your Membership renewed on terms no less favorable than those offered to other similar Members by us, unless at least sixty (60) days prior to the date of expiration of Membership, you are provided with a notice of our intention not to renew the Membership beyond the agreed expiration date. A notice of cancellation or non-renewal shall state with reasonable precision the facts on which our decision to cancel or non-renewal is based. Problems With Insurance? Be advised, if you are having problems with your insurance company or agent, do not hesitate to contact the insurance company or agent to resolve your problem. You can also contact the Office of the Commissioner of Insurance, a state agency that enforces Wisconsin's insurance laws and file a complaint. You can contact the Office of the Commissioner of Insurance by writing to: Office of the Commissioner of Insurance Complaints Department, P.O. Box 7873, Madison, WI 53707-7873. Or you can call 608-266-0103 and request a complaint form.


SafeRide Motor Club, Inc.

Driver Select Plan

Member Name: Member Number: Effective Date: Member Vehicle:

To obtain Emergency Road Services, or any other benefits listed on your membership registration form, please call (toll free):


Your emergency roadside assistance plan provides delivery in the event you are in need of towing or any other listed plan service. There is no coverage for unauthorized services.

Services provided by SafeRide Motor Club, Inc. 13901 Midway Road, Suite 102-429, Dallas, TX 75244-4388.

William Breindel, President SafeRide Motor Club

SafeRide Motor Club, Inc. 5001 Spring Valley Road, 350W Dallas, TX 75244-4388. 1-888-664-4561

Office Locations

SafeRide Motor Club, Inc. C/O National Registered Agents, Inc. 12 Old Boston Post Road Old Saybrook, CT 06475

SafeRide Motor Club, Inc. C/O National Registered Agents 818 W. Seventh Street Los Angeles, CA 90017

SafeRide Motor Club, Inc. C/O National Registered Agents, Inc of Nevada 311 S. Division Street Carson City, NV 89703

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