Wholesale Customer Pick Up Request

Email address:

Shop Name:

 

 

Shop Phone:

Contact Name:

Address:

City:

State:

 

Shop Close Time:

Contact Phone:

 

P.O./Job #:

 

R.O. #:

 

 

Year:

 

Make:

 

Model:

 

VIN:

 

Qty of Wheels:

 

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)?

 

 

Type of Repair:

 

Color:

Specify Color:

Special Instructions:

Upload pictures:

Upload repair document: