PRO-LEASE TICKET FORM
Truck Number
Driver ID
Name
Email
Phone
Truck Location
Who is your IC Advisor or Planner
Please Select One
Urgent Breakdown
Schedule Mechanical / Service Repairs
Maintenance Escrow Balance Inquiry
Payment History Inquiry
Amount Owed Inquiry
Other (Please describe below)
Is Your Truck in Derate?
Yes
No
If Truck is in Derate How Many Hours Are Left?
Is There a Check Engine Light On?
Yes
No
Please Describe Check Engine Light
Are You Under a Load?
Yes
Yes Critical Load
No
When is Delivery Due?
Are you on a 10 or 34 HR break?
Yes, I want to try to resolve the issue during my break.
Yes, but I will need to address issue after my break.
No
Please Provide a Brief Description of Issue / Question
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