Form 2 Dealer Contact

Form Date*

Date

This submission is for?

United StatesCanadaLatin America

Engine Group Requesting For?

DEUTZDaimler (MTU/Mercedes)DEUTZ & Daimler

Reason for Request*

Annual SubmissionNew Account Setup

DEUTZ Business Type*

DEUTZ Distributor (Not OEM)CC3 Full Service DealerCC2 Limited Service Dealer

Business Name*

Your DEUTZ Account Number (GPA)*

ex: 901****

Business Phone Number*

Country CodeArea CodePhone Number

Your Name*

First NameLast Name

Your E Mail Address*

example@example.com

Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Business Web Address*

Business FAX Number

Area CodePhone Number

Enter "NA" or "NA@NA.com" for any that do not apply.

General Manager*

First NameLast Name

General Manager E Mail*

example@example.com

Parts Manager*

First NameLast Name

Parts Manager E Mail*

example@example.com

Warranty Admn "DiWi User"*

First NameLast Name

Warranty Admn E Mail*

example@example.com

Service Manager*

First NameLast Name

Service Manager E Mail*

example@example.com

Training Manager (if available)

First NameLast Name

Training Manager E Mail

example@example.com

Please list the primary OEM brands you are currently affiliated with:

Primary OEM*

DEUTZ Primary OEM*

Please list the DEUTZ powered OEM brands you are currently affiliated with:

DEUTZ PWRD OEM #1

DEUTZ PWRD OEM #2

Your hourly service shop labor rate should be within the market's norm and verifiable on a customer paid invoice. Please complete the section below and attach a copy of one paid customer invoice that clearly shows your hourly service labor rate.

Do you wish to change your labor rate?

YesNo

What is your current posted shop labor rate (DEUTZ/Daimler Specific)?*

Ensure amount is expressed in USD

Current Shop Labor Rate

Ensure amount is expressed in USD

Invoices must detail number of hours billed for labor. If that is not included on your invoice, provide the work order associated with the invoice that details those hours. If the number of hours billed are not provided, your labor rate increase will not be approved.

Paid Customer Invoice from last 90 days*

Browse Files

Invoice must be for shop labor, not field labor.

In the space below, please provide any circumstances and or justification for your proposed labor rate increase.

Are you a 24 Hour Service Provider*

YesNo

24 HR Hotline*

Country CodeArea CodePhone Number

Are you "MSHA Certified" Mine Safety & Health Administration*

YesNo

What engine families do you support at this location?*

Distributor & CC3 full service dealers support all engine Families:*

What Daimler engine families do you support?*

SerDia DeCom Interface

One year from the date of submission of this form will become the date of expiration of each of the SerDia licenses you have listed below. Please note the new date of required renewal to avoid any interruption in service.

All assignees are required to maintain DEUTZ certification training.

Learning Management System Account Creation

Interface and Associated Assignee Registration Renewal*

Names listed above should not to be repeated below!

Additional DEUTZ Trained Technicians (Not listed above)

Total number of DECOM Interfaces residing at this location

1st Interface D#

2nd Interface D#

3rd Interface D#

4th Interface D#

5th Interface D#

6th Interface D#

7th Interface D#

8th Interface D#*

9th Interface D#

10th Interface D#

Total number of service trucks supporting this location (DEUTZ and NON DEUTZ):*

DEUTZ and NON DEUTZ trucks

Total number of technicians at this location (DEUTZ and NON DEUTZ):*

This includes all technicians within this facility (DEUTZ and NON DEUTZ)

Total number of DEUTZ trained technicians:*

Only include personnel that have completed at least (1) DEUTZ engine certification.

DEUTZ Learning Management System Account Creation

All DEUTZ distributors require a minimum of 2 trained technicians to meet KPI requirements.

All CC2 and CC3 DEUTZ dealers require a minimum of 1 trained technician to meet KPI requirements.

Total number of DEUTZ trained technician(s) (Must have an account in the Learning Management System)

DEUTZ Technician #1

First NameLast Name

Technician #1 DEUTZ LMS ID#

DEUTZ Technician #2

First NameLast Name

Technician #2 DEUTZ LMS ID#

DEUTZ Technician #3

First NameLast Name

Technician #3 DEUTZ LMS ID#

DEUTZ Technician #4

First NameLast Name

Technician #4 DEUTZ LMS ID#

DEUTZ Technician #5

First NameLast Name

Technician #5 DEUTZ LMS ID#

DEUTZ Technician #6

First NameLast Name

Technician #6 DEUTZ LMS ID#

DEUTZ Technician #7

First NameLast Name

Technician #7 DEUTZ LMS ID#

DEUTZ Technician #8

First NameLast Name

Technician #8 DEUTZ LMS ID#

DEUTZ Technician #9

First NameLast Name

Technician #9 DEUTZ LMS ID#

DEUTZ Technician #10

First NameLast Name

Technician #10 DEUTZ LMS ID#

New dealer applicants must check "YES" to the five questions below. The data entered above will pre-fill the form entries below during this process.

Do you need signage or truck decals?*

YesNo

Do you need to request TIS or SIS access?*

YesNo

Request or change a DiWi User Access?*

YesNo

Request or change a Web Portal access?*

YesNo

Do you need to request SERPIC?*

YesNo

It may be necessary to click through forms you did not select. Select continue below until you get to your desired business system request form.

DEUTZ Business Contacts & Labor Rate Form

Business Management Contacts

OEM Affiliation

Warranty Labor Rate

Service Operations Information

DEUTZ Business Systems

DEUTZ Signage Order Form

TIS & SIS Order Form

DiWi Order Form

DEUTZ Web Portal Order Form

SERPIC Order Form