SilverRock Request

Please enter the following information for wheel repair services. For questions, please call AWRS Claims at (877) 743-2977.

    CUSTOMER NAME *
    CLAIM/AUTHORIZATION #
    CONTRACT/POLICY #
    EMAIL ADDRESS *
    CELL PHONE NUMBER *
    FULL ADDRESS *
    VEHICLE YEAR, MAKE, & MODEL *
    VEHICLE VIN # *
    Mileage *
    WHEEL SIZE *
    WHEEL TYPE *

    WHEEL LOCATION & REPAIR TYPE

    Please select the wheel location and repair type for each wheel or not applicable.*
    LF
    RF
    LR
    RR
    LOOSE WHEEL
    COMMENT

    List any additional information relevant to the repair.

    IMAGE UPLOAD *

    Less than 5 MB please, Image is not required