Truck Country - Freightliner - Western Star Repair Communication Form

Stellar Industries Inc. Fleet Uptime Form

Date form Submitted:

Office

Phone

Author:

First Last

Model:

Unit #:

Odometer:

VIN # (last 6 digits):

At dealer?

Towed?

If not at dealer, when will it be?

Date:

Time:

DEALER

Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Contact comments:

DESCRIPTION OR PROBLEM

Please include if it has been worked on previously for problem(s) reported and what was done.