General Motors Request

DEALERSHIP BUSINESS ASSOCIATE CODE (BAC) NUMBER *

DEALERSHIP REPAIR ORDER # (required) *

GM DEALER NAME *

GM DEALER CONTACT NAME *

Street Address Line

Street Address Line 2

Zip Code

Country
United StatesCanada

Area Code

Phone Number

VEHICLE IDENTIFICATION NUMBER (VIN) *

DATE VEHICLE AVAILABLE FOR REPAIR *

WHEEL RPO
Note: Refer to RPO Wheel Refinishing Guide prior to submission

WHEEL SIZE

LF —Please choose an option—YesNo

RF —Please choose an option—YesNo

LR —Please choose an option—YesNo

RR —Please choose an option—YesNo

DESCRIBE CUSTOMER CONCERN *

COMMENT

IMAGE UPLOAD *