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wh Sweep
RFID
REQUEST FOR ENROLLMENT OF ADDITIONAL VEHICLE
[SUBSCRIBER INFORMATION
AccountName ‘Trower te (sas Orare sb siete ote aaiohe)
EMean cionen onsen
Account No. {he vetice is rolunder he name of scribe:
ova correo on Feed reread
Mobile No Soren nares
SThomny oe ae ote ered cae ee potent
re Sanu artereniees owe
\VEHICLE INFORMATION ‘Bose Alar
No.| Make | Wodsi | Year | Calor | Plate No | Condueon No | Vehicle Class_| Suter No.
5
7
‘Total No, of Vehicles
I hereby certty thatthe information provided herewith i tue, correct and complete. | voluntaiy disclose my petsonal information forthe
{alflment ofthis Agreement. | understand that any false, misleading, incorect or withheld information may cause the disapproval of this
requestor the termination of my Autoswieep RFID Account.
{Ihave read and clearly understood the Autosweep RFID Subscription Agreement and | agree and consentto be bound by the terms and
‘conditions of the Autoswieep RFID Subscription Agreement, including any amendments thereto, for allvehicles enralled under my RFID.
‘Account, including he above-Isted vehicles
‘Subs cibers Printed Name & Signature
Dae
