Repair Request form Web Site Registration Information Email * Shop Name * Shop Address * Shop Phone * Contact Name * Contact Phone * Department * Shop Close Time * P.O./Job # * R.O. # * Vehicle related Information Make * Year * Model * VIN Type of Repair * Full Remanufacture Straighten/Weld Back only Mobile Repair Qty of Wheels * 1 2 3 4 5 Wheel Location * Left front Right front Left rear Right rear Spare Unknown Color * Other Custom finish Gloss Black(95+%) Semi Gloss Black(50%) Matte Black(25%) Flat Black(0%) If other please write color
