Truck Down-Driver

PLEASE READ FULLY BEFORE SUBMITTING

PLEASE ONLY SUBMIT FORMS UP TO 24 HOURS PRIOR TO REQUESTING SERVICE. This form is used to report maintenance and/or parts needed, it is not an automatic approval and the vendor will need to call Gemini Maintenance to obtain a reference number at 1-844-643-6464. Any issues found on your vehicle inspection that will not be getting immediate attention should only go on your DVIR. If you are issued a reference number for parts and decide not to pick them up please call and cancel the open reference number.
Driver Name*

First NameLast Name
Driver Phone Number*

Area CodePhone Number
Driver E-mail
Enter only if you would like a confirmation email that your submission was successful, confirmation email is not an approval of repairs.
Truck Number*
PLEASE ENTER BOTH UNIT NUMBERS - EVEN IF UNIT IS NOT RECEIVING SERVICE!
Trailer Number*
PLEASE ENTER BOTH UNIT NUMBERS - EVEN IF UNIT IS NOT RECEIVING SERVICE!
Department
Refined/DEF/Tire Solutions
Unit Make
Unit Model
TruckTrailerTruck & Trailer
Engine Hours*
Mileage*
Maintenance Reason*
Tire Size*
Tire Position*
Photo

Upload a Photo
Please upload a photo(s) of the tire(s) that needs replaced Cancelof
Why are you unable to upload photo of tire?
NoYesOther
Is the unit currently at the shop?*
Shop Name*
COMPANY NAME ONLY, PLEASE DO NOT INCLUDE LOCATION IN THIS FIELD
Shop Phone Number
IF KNOWN
Shop City*
REQUIRED
Shop State*
REQUIRED
If shop is not a Love's or Speedco please select a reason
If not a Love's or SpeedCo this field is required.
Maintenance Description*
Email
example@example.com
Regional Manager*
Date

MonthDayYear
Date
Time

:HourMinutes
Should be Empty:

PLEASE READ FULLY BEFORE SUBMITTING