Wheel Collision Center
7286 Penn Dr. Bath, PA 18014
800-292-7467
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Street
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Daytime Telephone Evening Telephone Fax

Vehicle #1 Year Make Model
Quantity Size Description
Vehicle #2 Year Make Model
Quantity Size Description
                  
Straighten Only, If Possible Refinish Only, If Possible Chrome or Rechrome Wheels
Repair + Refinish Custom Polish Refinish Back of Wheel
Refinish Center Caps
Custom Paint Paint Code Description
Core Wheel Return Core Return Number (Call)
Warranty Wheel Return Warranty Return Number (Call)
Discard Tires Remount and Balance Tires Provide Pricing on New Tires
Other

How did you find out about us?

Internet Car & Driver Roundel Modern Tire Dealer Road & Track
Panorama Car Buyer's Guide Auto Week Vette Referral
European Car Star Trade Show Other

PLEASE: Include a printed copy of this form when shipping wheels for repair/refinish for more efficient handling.