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GCR
 

GCR Tires & Service
Online Road Service Request

Please complete the form below to submit a request for emergency road service. A GCR representative will contact you.

 
 
 
Account Information
* required fields
Method of Payment: *
Account #:
Company Name: *
Company City: *
Company State: *
Contact Name: *
Contact Email:
Contact Phone: *
Communication Preference: Email: Phone:*
Driver Name:
Driver Phone:
Reference #:
PO #:
 
Vehicle Information
Service Needed: Tractor: Trailer: Other:*
 
Cause of Failure:
Disposition of Off-Tire:
 

Tractor #:
Vehicle Type & Color:
# of Tires:
Tire Position:
Tire Size:
Tire Preference:

Trailer:
Vehicle Type & Color:
# of Tires:
Tire Position:
Tire Size:
Tire Preference:

Other:
Vehicle Type & Color:
# of Tires:
Tire Position:
Tire Size:
Tire Preference:
 
 
Wheel Information
Wheel Needed:    Yes: No:
Description:
 
 
Mechanical Information
Mechanical Needed:    Yes: No:
Description:
 
 
Breakdown Location
City *
State *
 
 
Detail Location Include the address, interstate, highway, exit, mile marker # and specific location.
  *
 
 
Additional Information
 
 
 
Once you submit your road service request, you should receive a confirmation message and email with the submitted breakdown information. If you do not receive this, please contact GCR at
1-800-541-8473.
 
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