Service Request - Duzzy's Roadside

You Are Here: Home / Service Request

Service Request Form

Fields marked with an ^* are required.

"*" indicates required fields

New Customer Questionnaire

Already existing customer? Please visit your customer portal to submit a request. If you need access to your customer portal, contact us.

Company Name*

First Name*

Last Name

Phone*

New Unit Questionnaire

VIN

Year

Make

Model

Unit Number

License Plate

Service Request Questionnaire

A complaint is an issue that you are having with the unit. Please describe the problem or request as thoroughly as possible. The better you describe the problem, the better chance we have at identifying and repairing. For example, “The A/C works great in the morning, but in the afternoon it slowly starts blowing hot.” If you have multiple issues/complaints, add them separately by clicking the “+” button.

Complaints, problems or requests*

Scheduling & Authorization

When will the unit be available for repairs?

Time

Unit Availability Confirmation

The unit MUST be accessed at the above date and time.

When would you like the unit back?

Time

Unit Return Date Confirmation

Return ASAP

How would you like us to access the unit?*

Additional notes for pick up

Would you like the shop to deliver the unit?*

Additional notes for drop off

Authorization Number

PO Number

Add Additional Information such as Unit Identifier, Driver Name, or Reference #

Additional Information

Unit Identifier

Use this optional field for information such as "black w/ red stripe" or "parked by bay 2 door" that might be useful in finding the unit.

Driver Name / #

Use this optional field to enter the driver’s name / number.

Engine

Use this optional field to enter any pertinent engine information.

Reference #

Use this optional field if there is a reference number, including what type of reference number it is.

How did you hear about us?

Please enter how you heard about us (e.g. shop website).

This field is for validation purposes and should be left unchanged.

Call Us

Want to talk to a real person? We’re in the office from 8 a.m. to 5 p.m.

(618) 535-1166

Email Us

Got a question that isn’t pressing? Drop us an email! We’ll get back to you within one business day.

dispatch@duzzysroadside.com