VEHICLE TRACKING CONTRACT
Name: Tel Work:
ID Number: Tel Home:
Vehicle Reg: Cell:
Postal Address: Fax:
INSURANCE
Physical Address: Broker:
Policy Number:
E-mail: Medical Aid:
Medical Number:


BANKING DETAILS (For Security Reasons, Fill in This Section Manually After Printing)
 
Account holder:   Branch Code:  
Bank Name: Account Number:
Account Type:  
Authorised Signatory: Authorised Signatory:
       


EMERGENCY CONTACTS
 
Name:   Name:  
Tel Work: Tel Work:
Tel Home: Tel Home:
Cell Number: Cell Number:
       

UNIT DETAILS VEHICLE DETAILS
         
Unit Number Vehicle Registration
Unit Location Make
Installer Name Model
    Colour
COSTS Passenger Commercial
Unit Cost Chassis Number
Unit location Engine Number
Additional    

DRIVER DETAILS
     
Name
Tel
Address
Cell

OPTIONAL SERVICES
          Price Plan A
Track and Trace AA Membership  
Ignition Reporting Extended Warranty  
Door Connection Input 1    
Disarm Via Alarm Input 2   Price Plan B
Disarm Via Button Panic  
Central Locking Geo Fencing    
           
           
       
           
  Australia Terms and Conditions (Read and Print)

ACCEPTANCE
I, the undersigned agree to abide by the terms and condition, and have read and understood them.

Signed _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Date _ _ _ _ _ _ _ _ _

On behalf of the Subscriber
 Signed _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Date _ _ _ _ _ _ _ _ _

On behalf of Star Trac