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Service Request Form
Please complete this repair request form as thoroughly as possible. The information you provide helps our technicians evaluate the concern and prepare for service. Submission of this form indicates you have reviewed and agree to our shop terms and conditions. This form typically takes 2–3 minutes to complete.
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.
Driver Name (if different from above)
First Name
Last Name
Driver Phone Number
Please enter a valid phone number.
Service Details:
Information about equipment needing service.
What service are you looking for?
In Shop Service
After Hours Mobile Service
Regular Hours Mobile 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.
Payment Form
*
Please Select
Cash
Check
EFS Check
T-Check
COMcheck
Credit Card *3.25% convenience fee*
Confirm you understand our In-Shop Service Rate is $175 per hour - with a 1 hour minimum.
*
Yes
No
Confirm you understand our Mobile Service Rate is $205/hour with a 2 hour minimum - $100 call out fee - $3 per mile.
*
Yes
No
Confirm you understand our After Hours Mobile Service Rate is $255/hour with a 2 hour minimum - $200 call out fee - $3 per mile.
*
Yes
No
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 service rates, policies, and procedures of Deckplate Diesel LLC.
*
Submit
Submit
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