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Run: Costco Tire Center Member Fitment Refusal Documentation

Document a tire installation refusal when a tire does not meet vehicle fitment requirements. This form captures the vehicle, tire details, policy basis, memb...

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Customer and Vehicle Information

Member name (required)

Member number

Optional unless needed to locate the service record. Do not collect more PII than necessary.

Vehicle year (required)

Vehicle make (required)

Vehicle model (required)

License plate

Optional if needed for service identification.

Service date (required)

Service order number

Tire and Fitment Details

Tire brand (required)

Tire model (required)

Tire size (required)

Enter the tire size exactly as marked on the sidewall.

Load index / speed rating

Fitment issue type (required)

Fitment issue details (required)

Describe the observable reason the tire does not meet fitment requirements.

Policy Basis and Decision

Supervisor or manager name (required)

Decision maker role (required)

Decision (required)

Policy reference (required)

Reference the applicable store safety policy or manufacturer fitment requirement.

Decision rationale (required)

Explain why the tire was refused or escalated. Keep the explanation factual and specific.

Escalation needed?

Yes No N/A

Escalation reason

Member Communication and Alternatives Offered

Refusal explained to member (required)

Alternatives offered (required)

Alternative details

Provide details only if an alternative was offered or discussed.

Member response

Member acknowledgment

Optional signature if the member agrees to acknowledge the refusal documentation.

Submission Notes and Audit Trail

Additional notes

Use this field for brief factual notes only. Avoid sensitive personal data unless required for the service record.

Supporting documentation

Optional upload for tire sidewall photo, fitment reference, or related documentation.

Recorded by (required)

Name or identifier of the associate completing the form for audit trail.

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Email (required)

Your name (optional)

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