Mercedes-Benz Commercial Vehicles

COMPANY DETAILS

Company Name:

Physical Address:

Address Line 1: *

Address Line 2:

Suburb: *

Postal Code: *

P.O. Box:

P.O. Box No:

(e.g. 12345)

Suburb:

Postal Code:

Country: *

Province: *

Company Registration No:

/ / (e.g. 2000/031484/07)

Telephone / Switchboard: **¹

- (e.g. 011-1234567)

Fax:

- (e.g. 011-1234567)

Company Fleet Size:

Buses - Front Engined
Actros
Axor
Sprinter

Buses - Rear Engined
Atego
Vito
Other

CONTACT PERSON DETAILS

Title: *

Initials: *

(e.g. AB)

First Name: *

Surname: *

Position / Designation:

CEO Owner/Driver Fleet Owner Driver Other

E-mail Address: *

e.g. firstname.surname@provider.co.za

Daytime Telephone No: **¹

- (e.g. 011-1234567) Work Home

Cell No: **¹

- (e.g. 082-1234567)

* indicates required fields.
**ⁿ indicates that at least one field is required in group ⁿ.