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