Title Page
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Dealer Name
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Technician Name/No:
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RO Number (If available)
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Rego No (If available)
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CUSTOMER / COMPANY NAME
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DRIVER NAME & CONTACT:
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During hours / After hours
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Payment Terms
Breakdown/Offsite Detail Form
TRIP INFO
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CALL TIME:
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START LOCATION (Location / Postcode)
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Service Vehicle Start Km’s:
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TIME ON SITE:
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LOCATION OF BREAKDOWN:
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TIME FINISH ON SITE:
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FINISH LOCATION (Location / Postcode)
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Service Vehicle End Km’s:
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TIME HOME:
Vehicle Info:
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MAKE & MODEL:
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VIN:
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Odometer:
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Customer Signature
Job Story
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Complaint - (What is the failing function?)
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Cause - (Include diagnoses to find the cause)
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Correction - (State how it was rectified)
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PARTS USED & NOTES:
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Repair (Type)
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Tow Provider
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Provide details of requirements / arrangements for full repair to be completed