Registration

Purchased from

Dealer Name*

personal

Account Name*

First Name*

Last Name*

account

Login Name*

Clients Email*

asset

IMEI (recorded on device)*

Name / Registration*

Asset Type*

Make*

Model*

Color*

Year*

Solution Type *

Service Plan*

Fitment Options

Installation Location

Initial Mileage (km)

Initial Engine Hours (h)

Notes

Has the device been installed and the asset currently has power ?

No

Yes

Connected to Ignition ?

No

Yes

Contact

Address*

City*

State / Province / Region*

Zip / Postal Code*

Country*

Time Zone*

Language*

Mobile*

Emergency Contacts (Optional)

Contact #1

First Name

Last Name

Email

Phone

Contact #2

First Name

Last Name

Email

Phone

Payment Type

By Invoice

Credit Card (Stripe API)

BECS Direct Debit (Stripe API)

Subscription Code

By providing your bank account details, you agree to this Direct Debit Request and the Direct Debit Request service agreement, and authorise Stripe Payments Australia Pty Ltd ACN 160 180 343 Direct Debit User ID number 507156 (“Stripe”) to debit your account through the Bulk Electronic Clearing System (BECS) on behalf of Automotive Technology Group Australia (the "Merchant") for any amounts separately communicated to you by the Merchant. You certify that you are either an account holder or an authorised signatory on the account listed above.

Credit Card Number*

CVV*

Expiry Date*

Name on Card*

Invoice Name*

Invoice Number

Tax ID

Email Address for Invoice*

Code*

I agree to be bound by the Terms and Conditions which can be found at policy.cartrack.co