Road America Roadside Assistance For Box Trucks up to 14,500lbs

Please Fill in the Information Below to Register Your Inventory
This Form will only Accept 10 Vehicles.
If you wish to register more than 10, simply fill out multiple forms.

 YearMakeModelMileageLast 10 Vin
Check the number of vehicles on this form for a full year at the special rate of only $105.00 per car. 

Qualified vehicles must be under 10 years old and under 200,000 miles. 

Remember it takes 3 business days for your vehicles to be entered into the system!
Current Total:

Please Enter Your Company Information

Company Name
Contact Person
Mailing Address
Phone Number
Fax Number
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