Company name*

TitleMrMsDr

Decision Maker's full name*

Address

P.O. Box*

Postal Code

City*

Country*

Telephone

Fax

Mobile*

E-Mail*

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What type of industry is your company?Advertising & MediaBanking & FinanceConstruction & Real EstateOil & GasIT & TelecommunicationManufacturingTravel & TourismShipping & LogisticsOther

Is your company a subsidiary?NoYes

If your answer is "Yes", please fill in the name of the parental company in the next field.

Does your company have subsidiaries?NoYes

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Does your company have representation in other Middle East countries?NoYes

If your answer is "Yes", please mark the countries in the following checkboxes.

Abu DhabiDubaiKuwaitOmanQatarSyriaBahrainJordanLebanonPakistanSaudi ArabiaYemen

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How many cars do you have on your fleet?

How many years do you keep your company vehicles?1-2 years2-3 years3-4 years4-5 years

Please give us the contact details of the main decision maker/s [1].

[1] only if different from company details _____________________________________________________________________________

Preferred language of communicationEnglishArabic

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I hereby declare that the information provided in this enrolment form is true to the best of my knowledge and I apply for Daimler Fleet Account Number on behalf of my organization.