IntelliTrac Fleet Management System Order & Application Form 

24 Month Agreement for the Provision of Internet Application Hosting and Terms and Conditions of Sale

 

For assistance in completing this form please call 1300 767 492

Company Details

*Blue Indicates Mandatory Fields
Registered Company Name (If Pty. Ltd or Ltd)
Trading Name
ABN
Street Address
Address (cont.)
Suburb
State
Post Code
Work Phone
FAX
Company Website Address
   

Purchase Order Details

 
Name of Person Placing This Order
Position Held
Email Address
Phone
Fax
Mobile Telephone Number
Purchase Order Number Please fax purchase order to 03 9466 7188
   

Accounts Payable Details

 
Accounts Payable Contact Name
Email Address
Phone
Fax
   

Billing Details

 
Billing Street Address
Suburb
State
Post Code
   

User Login Details

Additional users may be allocated when this application is accepted
Preferred Username
Preferred Password
  Vehicle Make Vehicle Model Voltage Rego Allocated Driver Preferred name of this device Vehicle Type Type of GPS Required RF Driver ID Reader Refrigerated Temp Monitoring Message Data Terminal SOS Button Security Monitoring Service
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

    

Security Monitoring Service Details The fields below are mandatory only if you have selected security monitoring as part of your fleet management system
Contact To Call In Case Of Alarm Condition
Date Of Birth
Phone
Mobile
Afterhours
   
Alternate Contact
DateOf Birth
Relationship to Primary Contact
Phone
Mobile
Afterhours
   
CodeWord (This will be requested by security operations)
MothersMaidenName (This will be requested if Codeword Forgotten)

 

Pricing for Supply Of Devices

 
Total Price Quoted  AUD$ + GST
Quotation Number
Quoted By IntelliTrac Representative
   

Mobile Data Preference

   

Calculation of Monthly ASP Fees

 
Number of Tracking Systems Required
Monthly Fee to host each tracking system
Total Monthly Fees   + GST

Calculation of Annual Security Monitoring Fees

 
Number of Systems Requiring Monitoring
Annual Monitoring Fee Per Device
Total Annual Monitoring Fee Payable in Advance + GST

 

Any special comments you wish to add

Terms and Conditions of Sale:- Please read carefully and acknowledge

If you agree with the terms and conditions of sale please answer YES (type in capital letters)

 

 


 
 
 
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