THE FAMILY MAINTENANCE
MOBILE ASSISTANCE
Today's Date
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Month
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Day
Year
Date
Hour Minutes
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PM
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Owner Name
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First Name
Last Name
Driver Name
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First Name
Last Name
Driver Number
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Please enter a valid phone number.
Company Name
*
Kemet Solutions LLC
KS Michael Group
Darbys Choice LLC
KTS Elite Transportation
Atlantic Building Construction
White Construction
Stazz
R&E Transport
Valiant Transport
Lezar Trucking
Jack Luv
KL&A Transportation
KJ Gardens
Other
*If other was selected enter Company Name:
Truck Number
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Are you requesting mobile mechanic?
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Yes
No
Enter Location of Vehicle
Truck issue picture
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Signature
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Briefly describe what issues you are having as to allow us to better assist you
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Please initial you have read the following: A $120/hour rate will be charged for maintenance and $75 for a diagnostic fee.
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Please Initial you have read the following: The amount paid by Kemet Advance plus a fee of 10% of the total payment made will be deducted from your upcoming paycheck issued from Kemet Solutions to satisfy the debt incurred. Kemet Advance holds no responsibility or liability nor offers any warranty or guarantee for any part(s), services or repairs related to this transaction.
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