Ford Stellenbosch Fleet Customer Contact Database Update

1. Company Name:

2. Physical Address:

3. Industry Type:

4. Region:

5. Fleet Manager Name:

6. Fleet Manager Telephone:

7. Fleet Manager Email:

8. Purchasing Manager Name:

9. Purchasing Manager Telephone:

10. Purchasing Manager Email:

11. Owner / Director Name:

12. Total Fleet Size (number of vehicles):

13. Passenger Vehicles (quantity):

14. Light Commercial Vehicles (quantity):

15. Medium Commercial Vehicles (quantity):

16. Other Vehicle Types (please specify):

17. Vehicle Types Included in the Fleet (models or body types):

18. Average Vehicle Age:

19. Vehicle Replacement Cycle:

Please select...2 years3 years4 years5 yearsOther

20. Other Vehicle Replacement Cycle (specify):

21. Primary Vehicle Application:

SalesService / TechnicalLogistics / DeliveryExecutive / ManagementOther

22. Other Vehicle Application (specify):

23. Who Drives the Vehicles:

Please select...Assigned driversPool vehiclesManagement onlyOther

24. Other Drivers (specify):

25. Financing Method:

Please select...Cash purchaseInstalment saleOperating leaseOther

26. Other Financing Method (specify):

27. Finance Provider:

28. Renewal Terms (contract duration and renewal process):

29. Fleet Management Company (if applicable):

30. Aftermarket Requirements (for example: accessories, branding, tracking, service plans, maintenance plans):

31. Downtime Sensitivity:

Please select...LowMediumHigh

32. Downtime Sensitivity Details:

I agree to the Terms & Conditions.

Customer Signature