Emergency Road Service Call Form
Dealer Performing Service
*
Royal Tire
Please Choose
Store
*
301 - St Cloud I94
303 - Minneapolis
305 - St Cloud Hwy 10
309 - Montevideo
310 - Marshall
312 - Monticello
313 - Virginia
317 - Brainerd
319 - Fergus Falls
321 - Savage
322 - New Ulm
323 - Grand Forks
328 - Waite Park
336 - Rochester
337 - Newport
342 - Duluth
StoreEmail
example@example.com
DM Email
example@example.com
Service Tech Name
First Name
Last Name
Tech Phone# (select store, then phone#)
Tech Text Email
Customer Company Name
*
Caller or Primary Company Email
example@example.com
Caller Name
*
First Name
Last Name
Call Back Number
*
Drivers Name
First Name
Last Name
Driver Phone Number
Site Address (Directions to work site)
Call Time (When call first came in)
*
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Month
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Day
Year
Date Picker Icon
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50
Minutes
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PM
AM/PM Option
Method of Payment
National Acct (Bridgestone)
National Acct (Michelin)
Credit Card (Verified by authorization#)
Accounts Receiveable (upon store approval)
Natl Acct Reference# (If Applicable)
Purchase Order# (if applicable)
Service Truck #
84
92
112
122
128
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132
146
162
178
188
214
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272
276
296
300
308
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336
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532
534
933048
Other
Service Truck Mileage at Store
Service Truck Mileage at Job Site
Job Start Time
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Minutes
AM
PM
AM/PM Option
Type of Equipment
Tractor - Class 7 or 8
Dump Truck/Cement
Trailer-Van
Trailer-Platform
Trailer-Heavy Haul/Low-Boy
Box Truck/Straight Truck
Commercial Van
Off-The-Road (OTR)
Passenger/Light Truck
Unit Number
Vehicle ID# (VIN#)
Unit Mileage or Hubometer (TRL)
Wheel Position
LF
RF
LFO
RFO
LFI
RFI
LRO
RRO
LRI
RRI
LF-Super Single
RF-Super Single
LR-Super Single
RR-Super Single
LF-TAG
RF-TAG
LR-TAG
RR-TAG
Rim/Wheel Damaged
YES
NO
Tire Size
295/75R22.5
275/80R22.5
11R22.5
445/50R22.5
455/55R22.5
315/80R22.5
285/75R24.5
275/80R24.5
11R24.5
10.00-20
255/70R22.5
245/70R19.5
Other
Enter Tire Item# and Qty
Enter Retread Barcodes (if applicable)
Replacement Tire or Repair
Enter description of tire or repair used
Tire DOT#(s)
Disposition Of Off Tire
Returned to Dealership and Scrapped
Returned with Customer
Returned to Dealership and Held For Customer
Tire Replacement Reason
Run Under-Inflated
Crown Cuts
Sidewall Cuts
Impact Break
Worn out
Mis-Match Tread Depths
Run to Destruction
Other
Tread Depth upon removal (if applicable)
Remove and Install QTY
Dismount and Mount - Vehicle QTY
Aluminum valve Stem QTY
Brass Valve Stem QTY
Flow Through Valve Cap QTY
Reconditioned Rim QTY
Additional Service Items
List valve extension lug nuts, studs, caps, etc...
Driver/Customer Signature
Printed Name
Comments
Photo Of Unit Number
Take Photo or Browse Files
Cancel
of
Photo Of License Plate
Take Photo or Browse Files
Cancel
of
Photo of Off Tire/s Before Work
Take Photo or Browse Files
Cancel
of
Photo of Tire/s After Work is Complete
Take Photo or Browse Files
Cancel
of
Service Complete Time
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Hour
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Minutes
AM
PM
AM/PM Option
Breakdown Location
Send Tech Text Message?
Yes
No
Tech - All Onsite Work Completed?
Yes
Manager Use Only - Form reviewed by Manager and ready to send to customer?
Yes
Submit
Should be Empty: