Vehicle maintenance and assistance request

>>>

Home Vehicle maintenance and assistance request

Vehicle maintenance and assistance request

Organisation Name

Vehicle type - Make model

Reg Number

Current Mileage

First Name

Last Name

Postal Code

Phone/Mobile

Have you or the vehicle been involved in an accident?

Please take all necessary precautions to ensure your safety and the safety of others.
If necessary, call emergency services or wait for assistance.
Once you are certain you are safe, contact our dedicated accident assistance specialist, M & G, at 0161 694 8057 to report the incident. You should also inform your line manager.

Do not admit fault to the third party.

Please obtain details of any third party involved in the accident.
You will need their name, address, telephone number, vehicle details, insurance company name and policy number.
Our insurance details are included in your driver pack and will be emailed to you once you have completed this form.
Please take photos of the accident damage and the surrounding area with your phone. You can either upload the images here or send them to us later.

Image Upload

Choose File

Is your vehicle broken down or undriveable

Please call the emergency breakdown service provider associated with your vehicle—there is a list in your driver pack. We will email this list to you at the end of this form.

If your vehicle does not have cover, please arrange with your line manager to get the vehicle recovered or call us on 023 8009 019 for further assistance.

Please note here the issues you are having, for example, a flat battery, mechanical or electrical fault, flat tyre, vandalism, etc.

Once you have completed this form, we will email you with your driver pack.

Please give details of the breakdown.

Does your vehicle require a service?

Please provide details of service requirements here.

Would you like to upload any images?

Choose File

1. Do you require any further work?

Does your vehicle have a fault?

Please describe the fault.

Would you like to upload any images?

Choose File

2. Do you require any further work?

Does your vehicle require an MOT test?

Please tell us when your current MOT expires - if known, if not type "unsure".

Does your vehicle have any issues that need attention?

Would you like to upload any images?

Choose File

3. Do you require any further work?

Do you require Tyres or have a puncture?

In your own words, please describe your issue. This may be "I have a puncture" or "I need a Tyre replacement"

Tyre size - please report the Tyre size of Tyre/Tyres you have an issue with here. It should be three sets of numbers/letters, such as 205/18/R85

If worn - tyre depth must be less than 2mm in order to replace

If puncture/damaged are there any visible signs of damage or puncture, if so where

Has the emergency breakdown provider been called/attended?

Please upload images you think may help us

Choose File

4. Do you require any further work?

Replacement windscreen or glass

Description of issue

You will need to send us images of the damage for our insurers to examine. Please do that here

Choose File

what days or dates should we avoid

Please describe in your own words how we can assist you.

Please upload any images that may help us better understand your request.

Choose File

023 8009 0019

023 8009 0019

info@varissa.com

>>>