www.goodsamroadside.com Open in urlscan Pro
2606:4700:3033::6815:56fb  Public Scan

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

Form analysis 1 forms found in the DOM

POST /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

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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.

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