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Technician Dispatch

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

    TECHNICIAN DISPATCH

    TPA NAME *

    Contract/Policy Number *

    FIRST NAME *

    LAST NAME *

    EMAIL ADDRESS *

    PHONE NUMBER *

    STREET ADDRESS *

    CITY *

    STATE *

    ZIP CODE *

    VEHICLE YEAR *

    VEHICLE MAKE *

    VEHICLE MODEL *

    VIN *

    RO/PO *

    MILEAGE *

    AUTHORIZATION NUMBER *

    FACILITY NAME *

    FACILITY PHONE *

    CONTACT AT SCHEDULING FACILITY *

    CONTACT PHONE FOR SCHEDULING FACILITY *

    ADDRESS FOR SCHEDULING FACILITY *

    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