AUTHORIZATION TO EXTRACT VEHICLE DATA

The undersigned authorizes the dealership/service facility identified below to extract data from the
Data Recording Module (DRM) / Mimamori ECU in the commercial vehicle identified below, and to
use the extracted vehicle data to:

Obtain supplemental diagnostic data for use in servicing or repairing the vehicle; and

Generate vehicle Health Reports for the customer

The undersigned also authorizes Isuzu Commercial Truck of America, Inc. (Isuzu) and its affiliates
to use the extracted vehicle data for motor vehicle research and development, improvement and
safety improvement purposes.

Note: DRM / Mimamori ECU data is extracted by a download tool and laptop owned by the
dealership/service facility connected to a server owned by Isuzu.

Any additional VINs should be attached on a separate sheet of paper.

By signing below, the undersigned certifies that he/she is, or is the authorized representative of, the
vehicle owner. This authorization shall apply for a period of two (2) years from the date set forth
below, unless earlier revoked by the vehicle owner.

______________________________ _______________________________
NAME OF DEALERSHIP/SERVICE FACILITY VIN (LAST 8 DIGITS)

________________________________________ _________________________________________
DEALERSHIP TELEPHONE NUMBER OWNER/REPRESENTATIVE SIGNATURE

________________________________________ _________________________________________
NAME OF TECHNICIAN DATE

________________________________________
EMAIL ADDRESS

Please fax the completed form to:

Par-Tech
248-364-0370