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 *

    STREET ADDRESS *

    CITY, STATE & ZIP CODE *

    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