Roadside - Sign Up Form

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STEP 1 - Details
You must have a Fleet Card® account to be eligible for Fleet Card® Roadside.
If you do not currently have a Fleet Card please call 1300 307 159 or request a callback here.
First Name*
Last Name*
Email*
FleetCard™ Account Number*

This can be located at the top right hand side of your FleetCard™ tax invoice.
Name of Account Holder (e.g. company, partnership etc)*
(As per ABN Registry)

STEP 2 - Vehicle Description
Please complete the section below
- Select this box if you wish to add FleetCard™ Roadside to all vehicles registered on your Fleet Card® account.

Please enter the details of the vehicles you wish to register for Fleet Card Roadside: (Please complete all fields)
- select the '+' symbol if you wish to add multiple vehicles.

VEHICLE TYPE*	VEHICLE REGO	DRIVER NAME	YEAR OF BUILD	MAKE	MODEL	TRANSMISSION	VEHICLE FUEL TYPE

*Vehicle Type
Light = Sedan / Station Wagon /Light SUV up to 2.5 tonne GVM
Heavy = 4 X 4 / Light Commercial up to 3.5 tonne GVM
Additional Costs May Apply*
Additional Costs May Apply
- I acknowledge that costs in addition to the membership fee may apply where cardholders request certain goods or services. Please see the FleetCard™ Roadside Terms and Conditions for full details
Authority to Apply*
Authority to Apply
- I confirm that I am authorised to apply for FleetCard™ Roadside by or on behalf of the account holder named on this application
Terms & Conditions and Privacy*
Terms & Conditions and Privacy
- By ticking this box, I confirm that I have read and accept FleetCard's Privacy Policy and Fleet Card's Roadside Terms and Conditions
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Comments
This field is for validation purposes and should be left unchanged.

Fleet Card`®` Roadside

STEP 1 - Details

STEP 2 - Vehicle Description

Limited-time offer!
Up to 6¢ off a litre*

Fleet Card® Roadside

STEP 1 - Details

STEP 2 - Vehicle Description

Limited-time offer! Up to 6¢ off a litre*

Fleet Card`®` Roadside

Limited-time offer!
Up to 6¢ off a litre*