Obtain an Application

You can obtain an application form via:
Chrysler, Jeep®, Dodge or Ram Dealerships or FIAT® Studios
Or
From this website as a downloadable .pdf file

Download the application

Before Applying

Once you have decided to purchase a new Chrysler, Jeep, Dodge, Ram or FIAT vehicle that fits your transportation needs, contact a reputable and qualified adaptive equipment installer to ensure that it can be adapted to your specifications.

Steps for Reimbursement

  1. Obtain a prescription or note from a licensed medical doctor on physician’s letterhead for reimbursement of the adaptive equipment. (Some adaptations like driving devices and wheelchair or scooter hoists do not require a doctor’s approval. Check with your dealer and adaptive equipment installer to determine if a prescription or note is needed for your adaptations.)

  2. Complete an Automobility Application.

  3. Select a qualified adaptive equipment installer. Then, shop around and ask different installers for estimates to ensure a fair and reasonable price. Consider the warranty and service information as well as initial cost. Also, ask each company for a list of references. You can find qualified adaptive equipment installers and factory-approved conversion specialists at the National Mobility Equipment Dealers Association website.

  4. After your vehicle has been adapted, submit the following documents for reimbursement:

    • A copy of the application form – all signatures listed on the form must be obtained before sending
    • A copy of the adaptive equipment company’s itemized paid invoice
    • A copy of the signed Buyer’s Order / Lease Agreement
    • A copy of vehicle registration
    • A copy of your prescription or note from a licensed medical doctor on physician’s letterhead stating the specific diagnosis (when required)

    PLEASE DO NOT SEND ORIGINAL DOCUMENTS
    These documents must be mailed, faxed or emailed to the following address:
    AUTOMOBILITY PROGRAM HEADQUARTERS
    P.O. BOX 5080
    TROY, MI 48007-5080
    Contact Us by Fax: (855) 409-0475
    Contact Us by Email: rebates@chrysler.com

    Payment to the individual Automobility Program customer will be mailed within six weeks after receipt of an approved claim form and all required documentation is submitted.

Terms and Conditions

View the full Terms and Conditions

Still need help?

Contact Us:
Toll Free: (800) 255-9877
Hotline Hours: 8 a.m.- 8 p.m. ET Mon-Fri
Email: rebates@chrysler.com

Frequently Asked Questions

Q. What is the time limit for this reimbursement?
A. The adaptive equipment must be installed within six months of vehicle purchase or lease. A claim form and all associated paperwork must be submitted to Automobility Program Headquarters within 60 days of complete installation of adaptive equipment. (For complete guidelines, see the online application at Application form PDF or call (800) 255-9877.)

Q. Can this program be used as a rebate and applied to the purchase or lease price of the vehicle?
A. No. This is a reimbursement towards the cost of the adaptive equipment. If an eligible minivan is purchased or leased with a lowered floor already installed, the dealer has the ability to apply your $1,000 reimbursement at the time of sale. Reimbursements for all other vehicle and equipment applications will be sent directly to the customer after the completed application is received and will not be taken off the vehicle price at time of purchase. See your dealer for details.

Q. Can I use this reimbursement in addition to other Chrysler Group LLC incentives?
A. Automobility reimbursements are available to customers and may be in addition to any other applicable Chrysler Group LLC cash or lease incentive programs in effect at the time you purchase or lease your new vehicle. Also, the Automobility reimbursement will not be affected by any additional outside funding you may secure to help cover the costs of your vehicle conversion.

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1 Always check visually for vehicles prior to changing lanes.
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