ULB Breakdown - Unimark Trucking

ULB Truck Breakdown

Driver's Name(Required)

First Last

Date(Required)

Load #(Required)

OEM(Required)

Other OEM

Reference #

Need this from the customer's breakdown service.

Location of Breakdown

City State

Location of Repair Shop(Required)

Name of Repair Shop City State

Contact person at shop.

First Last

Contact Phone(Required)

Reason for breakdown(Required)

Number of trucks left at location & VIN #'s

# of Truck VIN #

Number of trucks left at location & VIN #'s

# of Truck VIN

Number of trucks left at location & VIN #'s

# of Truck VIN