Missing Visit Request Form

Instructions:

Fill out the form completely.

Example of a Check:

Guest-Receipt-Example

MISSING CLAIM FORM:

Please fill out the form below completely to receive credit for your visit to your MotorClub account.

Missing Claims must be submitted within 30 days of the date printed on your receipt.

Thank you for your understanding.

Missing Claim Form
The email you used to sign up to the Motorclub. Without this, we cannot adjust your account.
Your guest receipt number is a 5 or 6 digit number located in the upper right hand corner of your guest check.
If you paid by credit card, please enter the last 5 digits of the card used for payment.
This must be the total charged including tax and tip. Remember, to earn a qualified visit, you must spend at least $15 BEFORE tax, tip and discounts.