OTR Wheel Engineering, Inc.
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Status of Take-Off Parts:
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Flat Repair
Mount/Dismount on Rim/Wheel
Mount/Dismount on Vehicle
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Wheel/Rim Replacement
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OTR Acct #:
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Customer Information
Branch #:
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Additional Customer Information
Email Address:
Customer PO #:
Work Order (Invoice) #:
Deliver To:
Additional Location Information:
Service Requester's Name:
Service Requester's Phone:
Service Date:
Unit #:
Hours on Machine:
Additional Machine Information:
Position to Service:
LF
RF
LR
RR
Other
Status of Take-Off Parts:
Customer Retained
Core—Return to Dealer
Warranty
If Warranty Selected, "Has OTR been contacted?"
Yes
No
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