SUBSCRIBER APPLICATION

For assistance in completing this form please call 0860 CTRACK.
Fax completed form to (012) 665-5376

To be completed and processed before acceptance of the order by DigiCore Fleet Management (Pty) Ltd.
DigiCore is under no obligation to accept the order.
Please tick the relevant boxes. Print legibly

If Company Purchase, skip to Section 2 and 3
 
1. PERSONAL DETAILS
   
Surname:
First Names:
   
Physical Address:
Code:
  Check to use Physical Address for Postal Address.
Postal Address:
Code:
   
ID No.
Tel. No.:
Fax No.:
Mobile No.:
E-Mail Address:
   
Employment status
Current Employer If your selection is Not employed, do not fill in these fields.
Contact Name at Employer:
Tel. No.: (Employer)
   
Marital Status:
Full Name of Spouse: If your selection is Not Married, do not fill in these fields.
Spouse's ID No.:


 
Have you or any person involved with this application ever been declared insolvent?
 
If "Yes" please furnish full details i.e. Date and Court this is a compulsary field if your previous selection was YES.
 
2. COMPANY DETAILS
   
Registered name of Business:
Reg. No.:
VAT Reg. No.: Not VAT registered, select checkbox
Reg. Name of Holding Co.:
   
Physical Address:
Code:
  Check to use Physical Address for Postal Address.
Postal Address:
Code:
   
Type of Company:


 
Details of Directors/ Members/ Partners:
Name: ID Number Residential Address Telephone No.
 
3. PRODUCT OFFERING BEING ORDERED:
     
Secure Recovery:  
Secure Web:  
Internet Report Version Daily Movement Report
  Trip Summary Report
  Full Trip report
     
Method of Payment:
 
Date: