Wholesale Customer Pick Up Request
Email address:
Shop Name:
Shop Phone:
Shop Address:
Contact Name:
Address:
City:
State:
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Shop Close Time:
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: