Wholesale Customer Pick Up Request
Email address:
Shop Name:
Shop Address:
Shop Phone:
Shop Close Time:
Contact Name:
Contact Phone:
P.O./Job #:
R.O. #:
Vehicle Info:
Year:
Make:
Model:
VIN:
Qty of Wheels:
1
2
3
4
5
Wheel Location:
Left Front
Right Front
Left Rear
Right Rear
Spare
Unknown
Request Driver remove wheels from car(please be aware there is an upcharge for this service)?
Yes
No
Type of Repair:
Full remanufacture
Straighten/Weld Back only
Mobile Repair
Color:
Match current finish
Other finish
Specify Color:
Special Instructions:
Upload pictures:
Upload repair document:
