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Mobile Service Request Form
Mobile service is on a first-call first-serve basis. Technician will reach out with ETA upon form completion.
Confirm you understand our Mobile Service Rate is $205/hour with a 2 hour minimum - $100 call out fee - $3 per mile.
*
Yes
No
Contact Information:
Person to make decisions on repair.
Company Name
*
Contact Person/ Account Authorizer
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Driver Name (if different from above)
First Name
Last Name
Driver Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Service Details:
Information about equipment needing service.
Address of Mobile Service
*
Type of Equipment
*
Please Select
Truck
Trailer
Other
Equipment Info
*
(Make, Model, Year)
FULL VIN Number
*
Unit Number (if applicable)
How many miles are on unit?
License Plate #/ State Registered
Issue (Be as specific as possible)
*
Be as specific as possible.
Upload Picture of Issue (Optional)
Browse Files
Drag and drop files here
Choose a file
Upload any pictures pertaining to issue.
Cancel
of
Accounts Payable
Payment Information
Purchase Order/Reference Number (If Applicable)
Accounts Payable Contact (if different from above)
First Name
Last Name
Accounts Payable Email
example@example.com
Accounts Payable Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Payment Form
*
Please Select
Cash
Check
EFS Check
T-Check
COMcheck
Credit Card *3.25% convenience fee*
If you need immediate assistance please call 701-929-0199 after submitting the form! We look forward to working with you!
By signing below, I acknowledge that I have read, understand, and agree to the rates and procedures of Deckplate Diesel LLC's Mobile Service Request.
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