The application form must be used to submit a claim for reimbursement under the terms and conditions of the program. Through this program Chrysler Group will provide a reimbursement to each eligible customer who installs qualifying adaptive driver or passenger equipment on a purchased or leased new Chrysler, Jeep®, Dodge, Ram or FIAT® vehicle. Contact your local dealer for Program eligibility dates. Only Chrysler Group LLC vehicles purchased or leased new and unused are eligible for payment under this program. Used vehicles are not eligible for this program. Certain types of fleet sales and leases may also qualify. Consult your dealer for eligibility requirements.
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 the Automobility Headquarters within 60 days of complete installation of adaptive equipment. Note that for a limited number of adaptations, such as driving devices and wheelchair or scooter hoists, the requirements for a medical note or prescription will be waived. Running boards, alerting devices and similar type adaptations must have medical documentation. Automobility Program Headquarters can answer questions about other adaptations at (800) 255-9877.
Adaptive equipment is defined as equipment required by persons with a permanent disability to drive, enter, exit and / or be transported safely in a motor vehicle. Factory optional equipment is not reimbursable under this program. A prescription or letter from a licensed medical doctor on physicianâ€™s letterhead may be required for reimbursement.
Conversions to Chrysler, Jeep®, Dodge, Ram or FIAT vehicles qualify for a maximum reimbursement of $1,000. Running boards qualify for a maximum reimbursement of $400. Alerting devices qualify for a maximum reimbursement of $200. This application form must be completed in its entirety and signed by the customer and the selling dealership.
Chrysler Group LLC will be the final judge as to the eligibility, interpretation and fulfillment of all elements of Chrysler Group LLC consumer incentive programs. Any payment or benefits received are subject to the Official Program Rules, provided to all participating dealers.
A copy of this application, a copy of the adaptive equipment companyâ€™s itemized paid invoice, copy of signed Buyerâ€™s Purchase / Lease Agreement, the vehicle registration, and a prescription or note from a licensed medical doctor on physicianâ€™s letterhead stating the specific diagnosis (when required) must be mailed to the following address:
AUTOMOBILITY PROGRAM HEADQUARTERS
Toll Free: (800) 255-9877
P.O. BOX 5080
TROY, MI 48007-5080
CONTACT US BY E-MAIL: email@example.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.