SafeRide America

Personal and Gift Membership Application

Fill in the information below to become a SafeRide America Member. Make sure you click "Submit" at the bottom of the page.  SafeRide America Membership requires recurring billing to your credit card.  In order to cancel your membership you must contact us via phone 404-888-0887 or email "" to cancel your membership or you may stop payment on your credit card. Your SafeRide America Membership will be automatically renewed each anniversary date (monthly or annually) and charged to your credit card on file without notice.  Please note that your membership number will be your cell phone number used below.  Please provide your member number when calling for service.  Thank you for becoming a SafeRide America Member.

Enter Personal Membership Information Here.

(If purchasing membership as a gift for someone, enter receipients information.)
I am purchasing this membership as a gift for someone.

Payment Information

Please choose your SafeRide America Membership type below. For member convenience, all memberships are placed on recurring billing and charged to your credit card each anniversary. Memberships may be canceled at any time by contacting us at 404.888.0887 or emailing us at Thank you for becoming a SafeRide America Member in support of our life saving mission. *
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Terms of Service Acknowlegment and Waiver

By providing your credit card information below you acknowledge you have read the below "SafeRide Customer Acknowledgement and Agreement" and agree to its terms. 

SafeRide Customer Acknowledgement and Agreement

 (1)  The undersigned customer gives permission to SafeRide America staff/contractors/volunteers to drive and operate his/her vehicle(s).

 (2)  The undersigned customer agrees to be fully and solely responsible for securing his/her vehicle(s) upon delivery of vehicle to his/her residence, including securing the contents of said vehicle(s). 

 (3)  The undersigned customer understands, acknowledges and agrees that SafeRide America and it's staff/contractors/volunteers are not responsible for any damage to his/her vehicle(s) or for any lost or missing items from his/her vehicle(s).  

 (4)  The undersigned customer confirms that he/she has insurance coverage compliant with the laws of the state in which services are provided on his/her vehicle(s) and agrees to hold SafeRide America and it's staff/contractors/volunteers harmless for any damage that may be caused to said vehicle(s). 

 As noted by providing my credit card and auto insurance carrier information below, I accept the above terms.  

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