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Truck Breakdown Repair welcomes you as a new customer and thanks you for imposing your trust in us. Be assured that as a valued customer, your business interests will be earnestly taken care of. Whether you need a mechanical help, a boost , a tow or onsite fuel delivery, Truck Breakdown Repair will provide you the best possible assistance when you or your drivers need it the most.

Becoming a customer is simple, quick, easy and FREE!

Please fill out the Form below and submit it. Once you have submitted your FREE application to become a customer, a customer service representative of Truck Breakdown Repair will contact you. If you have any questions or if you would like to request additional information; please call us at Toll Free Phone Number at 1-800-398-1666.

Customer Registration Form

*Note: Questions that are in red text are mandatory fields.

Company:   Contact Name:  
Address:   Title:   
City:   Province/State:  
Postal/Zip Code:   Country:  
Phone:   Fax:  
Email:    Website:   

Specify who is authorized to call Truck Breakdown Repair for emergency repair services.
Contact #1:

Contact #2:

Number of trucks your company operates:  

Number of trailers your company operates:  
Does your company issue purchase order numbers?
Yes     No

Would you like to be notified if a repair or service call exceeds a certain amount?
Yes     No

If yes, what is the amount excluding taxes?
(all repairs above this amount will require authorization)

Would you like to be notified when repairs or services are completed?
Yes     No

If yes, how would you like us to notify you?

Please specify names of people who can authorize repairs or services above your authorized limit.


Name: Phone: Cell:
Name: Phone: Cell:
Name: Phone: Cell:

After Hours/Weekends/Holidays

Name: Phone: Cell:
Name: Phone: Cell:
Name: Phone: Cell:
If we cannot reach any of the above authorized people when a repair or service is above your authorized limit, would you like us to continue with the repair or service, or would you like us to postpone the service call until the next morning?

Continue with repair or service call     Postpone Service Call
If after all efforts, Truck Breakdown Repair is not able to carry out the service call, who would you like us to contact?

Name: Phone: Cell:
Name: Phone: Cell:

Does your company prefer a specific tire brand?
Yes     No

If yes, please specify brand by location:
Steer axles:   
Drive axles:   
Trailer axles:   
What type of replacement tire do you prefer?
Brand New     Re-cap
Does your company have a national account with a tire company?
Yes     No

If yes, would you like us to use your account on your behalf?
Yes     No

How did you hear about Truck Breakdown Repair?
Enter First Name and Last Name in the boxes below:

I,      hereby confirm that the above information, supplied by me is correct in every respect. Furthermore, I have read and fully understand and agree with your terms and conditions listed in this web site. By clicking the 'Submit' button below, I confirm the above information and electronically sign and authorize Truck Breakdown Repair, to process my application.