Customer authorization

Roadside dispatch form

Complete and sign this form only after speaking with dispatch. It authorizes the stated initial limit; it does not confirm that a technician has been dispatched.

Call (915) 247-2782 first

Standard roadside pricing

$125 call-out fee per dispatch

$165/hour port-to-port

3-hour labor minimum ($495)

$2 per actual hub mile outbound and return

$25 fuel charge per call

Card customers prepay $645 plus estimated mileage

The $645 base is $495 minimum labor + $125 call-out + $25 fuel surcharge. Estimated mileage is added below at $2 per round-trip mile. Parts, applicable tax, and authorized additional work are extra. The call-out fee is separate from labor, mileage, fuel, parts, and tax.

Customer and contact

Customer / companyContact personTitle / authorityUSDOT number (if applicable)PhoneEmail

Unit and service request

Exact service location

Mileage calculates automatically after the location is entered. For highway calls, include the nearest city or ZIP with the highway and mile marker. Estimate only—not a quote. Billing is based on actual hub miles outbound and return. Dispatch confirms final travel and availability. Geocoding © OpenStreetMap contributors.

Estimated round-trip milesUnit / vehicle informationReported problem

Payment and initial limit

Do not enter a card number, expiration date, PIN, or security code anywhere on this form. For card payment, call dispatch. Your card is entered directly into the payment terminal and is not stored by this website.

Minimum labor: 3 hours × $165 = $495.00

Call-out fee: $125.00

Fuel surcharge: $25.00

Estimated mileage: Enter round-trip miles above

Estimated dispatch total: Pending mileage

Final mileage uses actual hub miles outbound and return at $2 per mile. Round-trip miles are counted once. Additional charges beyond the approved limit require approval.

Payment methodInitial approved limit (USD)

Electronic signature

Signer legal nameDate and time

Draw signature

I have read and accept the Dispatch & Service Terms, including 3 hours at $165/hour ($495), the $125 call-out fee, $25 fuel surcharge, and estimated round-trip mileage at $2/mile included in the displayed total. Final mileage is based on actual outbound and return hub miles. I approve charges up to the stated limit and understand the no-guarantee disclosure.I consent to electronic records and adopt the drawn signature as my signature. I understand the submission time, browser information, and server-observed IP address will be included in the record.

Dispatch & Service Terms

Effective September 10, 2026

Port-to-port time and dispatch scope. Billable time begins when the technician departs the applicable base or prior job and continues through travel, on-site work, and return travel or travel to the next assignment. Initial dispatch covers travel and diagnostics unless repairs or additional work are separately authorized. Dispatch does not guarantee restoration, a particular arrival time, or completion without towing, shop work, parts, or more labor.

Payment. Payment selection is required before dispatch. Accepted arrangements are cash, credit card subject to authorization and processor limitations, or a valid EFS/T-check. Personal checks are not accepted. Card details are provided directly to dispatch by phone and entered into the payment terminal.

Customer authorization. The signer represents that they are authorized to act for the customer and approve charges up to the stated limit. Work beyond that limit requires additional approval. The customer must provide accurate unit, location, access, and hazard information and a safe, lawful work area.

Electronic records. By checking the consent boxes and submitting, the signer agrees to conduct the transaction electronically, adopts the drawn signature, and agrees that the record may be retained and reproduced.

Independent provider. 915 Industries LLC is an independent repair provider. Manufacturer names identify platforms serviced and do not imply dealership, sponsorship, authorization, or factory affiliation. Texas law governs these terms to the extent permitted by law.

Roadside form privacy

The dispatch form collects customer/contact information, service location, unit information, reported problem, payment-method selection, approved limit, signer name/title, electronic signature, consent selections, submission time, browser identification, and the IP address observed by the server.

No payment-card data: this website does not request, collect, transmit, store, or email full card numbers, expiration dates, PINs, or security codes. Never place card information in any field.

Information is used to evaluate, authorize, dispatch, perform, bill, and document service; communicate with customers; maintain business/legal records; prevent fraud; and operate the website. It may be processed by service providers that host the dispatch system or deliver authorization email. If you use the optional mileage estimator, only the location text is sent to OpenStreetMap's Nominatim geocoding service; your name, phone, email, unit details, signature, and payment selection are not included in that lookup. 915 Industries does not sell personal information.

You may call instead of using the online form. Questions: info@915industries.com or (915) 247-2782.

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