Upload
kevin-matibag
View
224
Download
4
Embed Size (px)
DESCRIPTION
Now watch me whip, watch me nae nae. Watch me whip, whip, watch me nae nae
Citation preview
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