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  Customer :
  Type of equipment :
  Description of Breakdown :
  Location of Breakdown :
  GPS Coordinates :
  Email Address :
  Primary Contact Number :
  Secondary Contact :
  Type of Intervention :
  Strip and Quote (std rate)
  Immediate assistance needed
  Breakdown Roadside assist
  Customer Depot
  Service exchange needed

All after hour intervention will be subjected to break down service fee and traveling.

  Accept Standard terms and conditions :
  Click to accept
  Accounts Department :
  Contact Person :
  Order Number :