Name*EmailPhone*Pre-Booking Charges Approval* I grant my approval for charging me $125.00 Service fee and a 2-Hrs minimum (@$125/HR), a total amount of $375.00 before a tech is dispatched by Diesel Brothers. I also understand that once a tech arrives on-site, the $375.00 fee is non-refundable. Port-to-Port Rate* I understand that the port-to-port rate is hourly. I agree to pay the due balance(if any), once the job is done while the tech is on-site. I understand that Diesel Brothers doesn't guarantee any repairs to my vehicle. I understand that in roadside service, some vehicles may not be able to be repaired. I understand that in certain emergency cases, a tech might have to move from the site. In that case, a tech will return to finish the job as fast as possible. Driver's InformationDriver's name if different than customer's nameDriver's Phone NoVIN # (If Available)D.O.T Number (put zero's if no D.O.T. #)Unit NumberUnit Make/ModelBriefly describe the issueLocation of UnitCityPostal Code Roadside Assistance quantity Purchase