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MyPlugAndGo GPS Fleet Management Tracking Online Order Form

Agreement For the Purchase and Provision of GPS Application Hosting

Applicants must be ABN Holders. Payment is strictly by Credit Card  Direct Debit or Bank Account Direct Debit

 

Important- Direct Debit Forms Required to Process Your Order

Prior to Completing and Submitting this Electronic Form please download the banking and/or credit card Direct Debit Forms below.
Complete them  and Fax to IntelliTrac on (03) 94667188 when submitting this application.
 

Processing of your order will not commence until a direct debit form is faxed to  our office.

Company Details

*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*
   
IntelliTrac Sales Person

Insert the name of your IntelliTrac account rep for personal service

   
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-If Any

What Do You Want To Call This Vehicle? Please choose carefully as it is not easy to change later.         Vehicle Type Security Monitoring Service
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Pricing for Supply Of Devices

 
   
Type Of GPS Tracking Required  
   
 Trackers  
Price of Each GPS Device   +GST     
Number of GPS Devices Required                                              
Total Price GPS Tracking Devices   + GST    
   
   
   

Calculation of Monthly ASP Fees

 
 
Monthly Fee to host each tracking system +GST
Total Monthly Fees  + GST

 

Any special comments you wish to a

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)

Reminder - Prior to Submitting this form please download banking Direct Debit Forms below,
Complete them  and Fax to IntelliTrac on (03) 94667188 when submitting this application

 
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Copyright 2010© IntelliTrac. Privacy Policy 
Phone: 1 300 767 492

International: +61 3 9467 6188
Fax: +61 3 9466 7188