+ WINTER TIRE VERIFICATION FORM

Contact Info Uber Partner Name: ___________________________________________________________ Uber Partner Phone #: ___________________________________________________________ Vehicle Info Model: ___________________________________________________________ Make: ___________________________________________________________ Year: ___________________________________________________________ License Plate: ___________________________________________________________ To be completed by AGR Store #: ___________________________________________________________ AGR employee name: ___________________________________________________________ I (AGR employee)_______________________________________________, verify that the above vehicle info is correct and that the vehicle in question has 4 Winter Tires on it. ________________________________________________ ______________________ (AGR employee name) Date