TCM Reflash User ID Request Form

User Identification MAY NOT BE SHARED within a company. Each user must obtain his/her own unique
user identification by completing this form and returning it to Allison Transmission.

APPLICANT INFORMATION:
Name: Taleb Antar
Email Address: a-taleb@sacmi.com.tn
Phone: +21699433556

COMPANY INFORMATION:
Company Name: SACMI Distributor Code # 9272200000
Address: 20, rue de l'artisanat, Z.I. Charguia 2 Branch Code # 927220112
City/State/Mail Code: Charguia2/Ariana/2035 Phone: +21670873800
Country: Tunisia Fax: +21671838951
TYPE OF ID: Dealer Distributor Distributor OEM OEM ALLISON EMPLOYEE

SUPERVISOR/MANAGER INFORMATION
Name: Kouki Noureddine
Email address: n-kouki@sacmi.com.tn

ADD USER ID: DELETE USER ID:

Upon completion of top of form:

** FAX TO: 317-242-2712 **

THIS SECTION FOR ALLISON TRANSMISSION HOME OFFICE USE ONLY

Data Owner: MARK QUINN

Owner Signature: _________________________________________________________

Load Station User ID: _____________________ Date: _______________________

Revised July 2014