www.goodsamroadside.com
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Submitted URL: https://corporateroadside.com/
Effective URL: https://www.goodsamroadside.com/employee/enroll/
Submission: On August 10 via automatic, source certstream-suspicious — Scanned from DE
Effective URL: https://www.goodsamroadside.com/employee/enroll/
Submission: On August 10 via automatic, source certstream-suspicious — Scanned from DE
Form analysis
1 forms found in the DOMPOST /employee/enroll/index.cfm
<form class="form-horizontal" action="/employee/enroll/index.cfm" method="post" id="join">
<input type="hidden" name="action" value="step2a">
<input type="hidden" name="dbEmailAddress" value="">
<input type="hidden" name="CreditCardNumber" value="">
<input type="hidden" name="EigenTokenValue" value="">
<input type="hidden" name="paymentTypeId" value="">
<input type="hidden" name="PersonID" value="">
<input type="hidden" name="memberID" value="">
<input type="hidden" name="transactiontypeID" value="89">
<input type="hidden" name="thisTransactionGroup" value="Enroll">
<input type="hidden" name="usePromoCode" value="">
<input type="hidden" name="offerKeyword" value="">
<input type="hidden" name="pkgPromoCode" value="2TZI">
<input type="hidden" name="membership" value="2TZI|55.0000|12|1|89">
<input type="hidden" name="familyMembership" value="2TZJ|75.0000|12|1|89">
<input type="hidden" name="EmailPermissionIDList" value="">
<input type="hidden" name="BirthMonth" value="">
<input type="hidden" name="BirthYear" value="">
<input type="hidden" name="BirthDay" value="">
<input type="hidden" name="REFERPERSONID" value="">
<input type="hidden" name="PkgSeqNo" value="">
<input type="hidden" name="Customernumber" value="">
<input type="hidden" name="Quantity" value="1">
<input type="hidden" name="Goto" value="">
<input type="hidden" name="RememberMe" value="0">
<input type="hidden" name="GoodSam" value="0">
<div class="row">
<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12">
<h2>Enrollment <span class="text-nowrap">Step 1:</span></h2>
</div>
<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 mt-2">
<h3 class="h4">Contact Information</h3>
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input name="FirstName" id="FirstName" maxlength="50" type="text" value="" class="required form-field" placeholder="First Name">
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input name="LastName" id="LastName" maxlength="50" type="text" value="" class="required form-field" placeholder="Last Name">
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input type="hidden" name="addressID" value="">
<input type="text" name="Address1" id="Address1" maxlength="50" value="" class="required form-field" placeholder="Address">
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input name="Address2" id="Address2" maxlength="50" type="text" value="" class="form-field" placeholder="Address Line 2">
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input name="City" id="City" maxlength="50" type="text" value="" class="required form-field" placeholder="City">
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<select class="required form-field" name="State" id="State">
<option value="">State/Province</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="AB">Alberta</option>
<option value="BC">British Columbia</option>
<option value="MB">Manitoba</option>
<option value="NB">New Brunswick</option>
<option value="NL">Newfoundland and Labrador</option>
<option value="NT">Northwest Territory</option>
<option value="NS">Nova Scotia</option>
<option value="ON">Ontario</option>
<option value="PE">Prince Edward Island</option>
<option value="QC">Quebec</option>
<option value="SK">Saskatchewan</option>
<option value="YT">Yukon Territory</option>
<option value="NA">Other/NA</option>
</select>
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input name="ZipCode" id="ZipCode" maxlength="7" type="text" value="" class="required form-field" placeholder="Zip/Postal Code">
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<select class="required form-field" name="CountryCode" id="CountryCode">
<option value="USA|1">United States</option>
<option value="CAN|1">Canada</option>
</select>
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input name="PhonePrimary" id="PhonePrimary" maxlength="15" type="text" value="" class="required form-field" placeholder="Phone Number">
</div>
<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 mt-4">
<h3 class="h4">Billing Information</h3>
</div>
<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 text-left">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="SameBillAddress" id="SameBillAddress" checked="" onclick="document.getElementById('BillingAddress').style.display = this.checked ? 'none' : 'block';">
<label class="form-check-label" for="SameBillAddress"> Same as Contact Information </label>
</div>
</div>
<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12" id="BillingAddress" style="display: none;">
<div class="row">
<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 mt-2">
<p><small><em>Please enter the information that matches the credit card you wish to use.</em></small></p>
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input name="FirstNameBill" id="FirstNameBill" maxlength="50" type="text" class="billing form-field" placeholder="First Name">
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input name="LastNameBill" id="LastNameBill" maxlength="50" type="text" class="billing form-field" placeholder="Last Name">
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input type="text" name="AddressBill" id="AddressBill" maxlength="50" class="billing form-field" placeholder="Address">
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input name="CityBill" id="CityBill" maxlength="50" type="text" class="billing form-field" placeholder="City">
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<select class="billing form-field" name="StateBill" id="StateBill">
<option value="">State/Province</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="AB">Alberta</option>
<option value="BC">British Columbia</option>
<option value="MB">Manitoba</option>
<option value="NB">New Brunswick</option>
<option value="NL">Newfoundland and Labrador</option>
<option value="NT">Northwest Territory</option>
<option value="NS">Nova Scotia</option>
<option value="ON">Ontario</option>
<option value="PE">Prince Edward Island</option>
<option value="QC">Quebec</option>
<option value="SK">Saskatchewan</option>
<option value="YT">Yukon Territory</option>
</select>
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input name="ZipCodeBill" id="ZipCodeBill" maxlength="7" type="text" class="billing form-field" placeholder="Zip/Postal Code">
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 mt-4">
<h3 class="h4">Account Information</h3>
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input name="EmailAddress" id="EmailAddress" maxlength="55" type="text" value="" class="required form-field" placeholder="Email Address">
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input style="display:none" name="Password" id="Password" maxlength="20" type="password" value="employeedefaultpw" class="required form-field" placeholder="Password">
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input style="display:none" name="ConfirmPassword" id="ConfirmPassword" maxlength="20" type="password" value="employeedefaultpw" class="required form-field" placeholder="Confirm Password">
</div>
<div class="col-xs-12 col-sm-6 col-md-4 col-lg-4 text-center">
<input style="display:none" name="Hint" id="Hint" maxlength="50" type="text" value="employeedefaultpw" class="required form-field" placeholder="Password Hint">
</div>
<div class="col-md-8 col-lg-8 text-center"></div>
</div>
<div class="row">
<div class="col-xs-12" id="familyUpgrade">
<input type="checkbox" name="familyUpgrade" value="1">
<span><strong>Upgrade </strong> to Family Coverage for <strong>$<span class="upgradeDiff">20</span> More</strong></span>
</div>
</div>
<div class="row text-center">
<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 text-center form-submit-row form-actions">
<a class="beneplace-submit-btn btn yellow-bg text-black bold homepage-btn btn-lg btn-warning formbutton" id="btnNext">Next</a>
<p class="form-disclaimer-txt">Your Good Sam Roadside Assistance benefits become active 24 hours after approval of your payment.</p>
</div>
</div>
</form>
Text Content
Cookie Policy When you interact with our site, we use cookies and other technologies, some of which are provided by third parties, to operate and improve our site, serve advertisements, collect browsing and activity information, track user interactions, and otherwise collect and process information as described in our Privacy Policy. Click “Privacy Preferences” to review and opt out of certain types of cookies on this site. Okay Privacy Preferences ___ Home Benefits Contact Us Questions? EmployeeRoadside@goodsam.com Call us: 877-680-6150 GOOD SAM ROADSIDE ASSISTANCE CORPORATE DISCOUNT ENROLLMENT ENROLL NOW TO GET GREAT COVERAGE AND VALUE FOR LESS! Good Sam Roadside Assistance is a program that keeps drivers and vehicles protected in case of a roadside breakdown. Individuals will receive a drastic discount off the regular price of membership which is less than 1/2 that of our competition. AAA* Who is covered? Individual + Family Options Member + Additional Associate Option What vehicles are covered? All Autos, SUVs, Pickups, Vans, and Motorcycles All Autos, SUVs, Pickups, and Vans Must upgrade to include Motorcycles Unlimited towing to nearest repair center? Unlimited Limits Unlimited roadside assistance? Unlimited Limits Unlimited usage per year? Unlimited Up to 4 service calls Automotive and travel discounts? Yes Yes Coverage for personal vehicles used for business? Yes Yes Annual Individual Price Enter your promo code to see your offer $130 + Family for Low Fee + $85 additional EACH Associate Member* Enter Promo Code Submit ENROLLMENT STEP 1: CONTACT INFORMATION State/Province Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territory Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Other/NA United States Canada BILLING INFORMATION Same as Contact Information Please enter the information that matches the credit card you wish to use. State/Province Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territory Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory ACCOUNT INFORMATION Upgrade to Family Coverage for $20 More Next Your Good Sam Roadside Assistance benefits become active 24 hours after approval of your payment. Good Sam Roadside Assistance Benefits Include: Unlimited distance towing to the nearest service center Coverage includes Individual with Family Coverage Option Flat tire service, emergency jump starts, fuel and fluids delivery, lost key service Coverage in U.S., Canada, Mexico, Puerto Rico, and US Virgin Islands MORE BENEFITS 1 According to TopConsumerReviews.com, available on TopConsumerReviews.com published on 10/19/2017. *Information obtained from AAA of Colorado Plus Plan at Colorado.aaa.com on 9/29/2020 QUESTIONS? CALL US AT 1.877.680.6150 Benefits and services provided by Americas Road & Travel Club Inc. for Members residing in Alaska, Alabama, Utah, Virginia; and by Affinity Road & Travel Club LLC for Members residing in all other States. Note: All program benefits are subject to limitations set forth in the current Member Benefit Brochures, which will be sent to you upon approval of your membership. © 2024 Good Sam Enterprises, LLC. © 2024 Affinity Road & Travel Club, LLC. © 2024 Americas Road & Travel Club, Inc. All Rights Reserved. Terms of Use | Privacy Policy | Do Not Sell My Personal Information | California Privacy Rights