Here's how the Roadside Assistance Program works

Simply fill out the member information portion at the bottom of this enrollment form. Then detach and mail in, along with your check or money order for $49.95 to:

Nationwide Roadside Assistance
PO Box 26328
San Francisco, CA 94126

After your payment is received you will be receiving a welcome package containing your Nationwide Roadside Assistance membership card. On this card will be an 800 number which you will use to obtain all Nationwide Roadside Assistance services. Whenever you’re in a jam – your car breaks down, tire goes flat, no fuel – simply call the 24 hour member hotline and we’ll send a service provider to help get you back on the road. In cases where dispatch service cannot be provided, we’ll arrange to pay the bill for all covered expenses.

Yes, please sign me up for Nationwide Roadside Assistance!

1. Fill-in your membership information below.
2. Then, click the Print button to print this page.
3. Submit this application form along with your check or money order for $49.95 to the above provided address.

* First Name
* Last Name
* Address 1
Address 2
* Driver
* City
* Email
* State
* Main Number
* Zip Code
Alternative Number
* Signature