Service Schedule Request

Please provide as much information as possible and a customer service representative will contact you soon to confirm your repair appointment date and time.

lf you have immediate service needs, please contact us at the number listed below for the Western Branch Diesel, Inc. location closest to you.
* marks mandatory fields

General Info:

First Name: *
Last Name: *
Company Name:
Address: *
City, State, Zip *
 ,   , 
Phone #: *
Fax #:
Email: *
Engine/Transmission Serial #:
Customer lD # of Equip:
Equip Make: *
Equip Model: *
Equip Serial #:
Equip - Yr Mfg:
Equip Miles/Hours:
Is engine/transmission in warranty coverage period? *
   

Service Request:

Requested Schedule Date/Time: *
Please select type of repair: *

Please explain your service needs (Problem/Work required) *

Please select your Desired Location


© Copyright 2000 - 2009 Western Branch Diesel

Western Branch Diesel, Inc.
3504 Shipwright Street ~ Portsmouth, VA ~ 23703
Office: 757-673-7000 ~ Fax: 757-673-7190