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Now watch me whip, watch me nae nae. Watch me whip, whip, watch me nae nae
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Title Given Name Middle Name Last Name Nick Name
House & Bldg. No. Street Village/Subdivision City/Municipality Provice & Zip Code
Landline No. Fax No. Mobile No. 1 Mobile No. 2 Mobile No. 3
Other Informations
ID Presented ID No. TIN
OTHER CONTACT DETAILS (In case of Emergency)
Relationship Contact No (Landline) Contact No (Mobile)
o Registered Owner o Not the Registered Owner (User Only)Class Plate No Make & Model Year & Color Remarks
__________________________ __________________
Signature Date
POS Location POS Name & Signature Autosweep RFID Account No. Date Issued
AUTOSWEEP RFID SUBSCRIPTION FORM(PERSONAL)
Email Address
VEHICLE INFORMATION
I hereby certify that the information provided above is true, correct and complete. I voluntarily disclose my personal information for the
fulfilment of my Autosweep RFID account management. I understand that any false, misleading, incorrect or withheld information may cause the
disapproval or termination of the contract for the Autosweep RFID Services.
Customer's Printed Name
____________________________
TO BE FILLED UP BY Autosweep RFID REPRESENTATIVE
REMARKS (If Any)
Processed By
CONTACT INFORMATION
CUSTOMER INFORMATION
Complete Name
Requirements Checklistc Subscription Form
c Signed T&C Vehicle OR & CR
c 1-Valid ID
c Authorization letter (if not the registered owner)
c ID of the Registered Owner
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