CONNECTED CAR SERVICE REQUEST Connected Car Application What is your first name? * What is your last name? * What is your email address? * What is your phone number? * What is your physical address? (Please include city or town) Are you purchasing the service as an individual or an organisation? * Individual Organisation What is the name of your organisation? * Please select any additional services that you would like Panic button Multiple driver identification pack I-Button driver identification tag Immobiliser Driver identification installation charge None How many vehicles are you adding to the service? Your total for the services you have chosen is: What is your preferred payment method? EcoCash / Direct Bank Transfer In person with cash or swipe When would you like the installation to be done? Please submit your proof of identity (National ID or Passport) * Drop a file here or click to upload Choose File Maximum upload size: 516MB Please submit your proof of residence (Utility Bill) * Drop a file here or click to upload Choose File Maximum upload size: 516MB Please submit Certificate of Incorporation * Drop a file here or click to upload Choose File Maximum upload size: 516MB Please submit I.D's of Directors * Drop a file here or click to upload Choose File Maximum upload size: 516MB Please submit your Operating License Drop a file here or click to upload Choose File Maximum upload size: 516MB If you are human, leave this field blank. ContinueSUBMIT Use Shift+Tab to go back
