Company Details	*Indicates Mandatory Fields. Please do not use special characters such as #%&
Registered Company Name (If Pty. Ltd or Ltd)
Trading Name*
Trustee name
ABN*
ACN
Date Business Commenced
Business Structure	Select... Unlisted Pty Ltd Listed Ltd Co. Trust Partnership Sole Trader Govt Dept Subsidiary of Foreign Co. Association Trading Subsidiary Non Profit Organisation Incorporated Body Other
Nature of Business
Street Address*
Street address (continuing)
Suburb*
State*	Select... Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia
Post Code*
Postal address	If the same as the address above, please click here
Postal address (street)
Postal address (continuing)
Suburb
State	Select... Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia
Post Code
Main Contact Details
Title*	Dr. Miss Mr. Mrs. Ms.
First name*
Last name*
Position*	Accounts Director IT Manager Customer service Technical
Landline telephone number
Fax number
Mobile phone number
Email address*
Emailed invoice	Select...YesNo
Credit and external references
Credit limit*
Name of external accountant
External accountant landline No
Name of Trade Reference One*
Reference One Landline No*
Name of Trade Reference Two*
Reference Two Landline No*

Vehicle, Driver, Fuel card and GPS details
Number of Cards*
Vehicle #1 details
Vehicle make
Vehicle model*
Vehicle type	Select... Sedan Personal Tracking Device Wagon 4 WD Ute Truck Prime Mover Trailer Refrigerated Trailer Cement Mixer Coupe Convertible Mini Digger Bobcat Excavator Generator Garbage Truck Street Sweeper Water Flush Truck Boat Refrigerated Truck Van
Vehicle name
State Where the installation will take place	Select... ACT NSW NT QLD SA TAS VIC WA
Rego*
Driver details*
Title	Dr. Miss Mr. Mrs. Ms.
First name
Surname
Card fuel options*
Restrictions	Select... Fuel only Fuel and oil All products
GPS details
Type Of GPS Tracking Required
GPS Extras options	Select... BLITS Navigator Driver RFID system
Complete each section of the form above, then press the button below A list of vehicles is going to be created. Repeat the process to add a new vehicle in the list.

	Enter your promotional code
Pricing for Supply Of Devices - Summary
Trackers
Number of GPS Devices Required
Price of Each GPS Device	+GST =
Price to install each GPS Device	+GST =
Navigator Screens - Message Data Terminals
Number of BLITS Mobile Data Terminals-Nagivators Required
Price of Each BLITS Mobile Data Terminal - Navigator	+GST =
Driver RFID Readers and Tag
Number of Driver RFID Readers Required
Price of Each Driver RFID Reader	+GST =
Monthly ASP Fees
Number of Tracking Systems Required
Monthly Fee to host each tracking system	+GST =
Monthly Fee to host each BLITS Messaging-Navigation System	+GST =
MyCarsPlus  Cards
Number of MyCarsPlus Cards Required
Total Price GPS Tracking Devices	+GST =
Total Price BLITS	+GST =
Total Price RFID Reader	+GST =
Total Price of Installation	+GST =
Total Purchase Price of System	+GST =
Total Monthly Fees	+GST =

Any special comments you wish to add.   Max 255 characters  

Terms and Conditions of Sale:- Please read carefully and acknowledge. Print - the document will open in a new window

If you agree with the terms and conditions of sale please answerYES (TYPE IN CAPITAL LETTERS)

Person Acknowledging This Agreement
Acknowledgement title*	Dr. Miss Mr. Mrs. Ms.
Acknowledgement first name*
Acknowledgement last name*
Acknowledgement birth date*
Acknowledgement driver licence number*
Direct debit details*
Direct debit Financial institution name
Address of the financial institution
Direct debit BSB
Direct debit Bank Account Number
Direct debit Bank Account Name
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