Monthly Maintenance Report

For all lease equipment, submit this form to your dispatcher by the 5th day of the following month with copies of repair/maintenance receipts. Failure to submit accurate records on a timely basis may result in termination of your lease agreement.

Vehicle Owner

Make

Model

Vehicle Unit Number:

Date

Vin Number:

License Plate:

REPAIR RECORD

System

Odometer Reading

Date

Repair Description*

Breaks

Cab

Controls / Instruments

Clutch

Cooling / Heating

Electrical

Engine

Exhaust

Fifth Wheel

Fuel

Rear Axle, Driveshaft

Steering, Front Axle

Suspension

Transmission

Tires and Wheels

* Show specific item plus description of action: e.g. adjust, tighten, repair, replace – [example: replaced battery, adjusted brakes, repaired seat, etc.]

LUBRICATION RECORDS

Services

Date and Mileage

Change Oil

Change Filter

Grease

By submitting you declare that this report is true and correct to the best of your knowledge