FLEET REGISTRATION Please complete this form to register your organisation for a range of Mitsubishi Fleet discounts and benefits. Select your Registration type Fleet Manager Dealer Dealer - On behalf of Customer Please note - ABN registration check Before using this form, please ensure you have validated that this customer's ABN has not already been registered in SAP. If you require changes to an existing customer, please see your State Fleet Manager. 1 / 8 Dealership Details Dealership Name This field is mandatory Dealership Code This field is mandatory Contact Name This filed is mandatory. Name should contain only letters and no special characters or numbers Contact Phone This field is mandatory Please enter a valid mobile number. The mobile number must start with 0 and only contain numeric characters with no spaces. Contact Email This field is mandatory 2 / 8 Customer Contact Details Title (Please select) Dr Mr Mrs Ms Miss First Name This field is mandatory. Name should contain only letters and no special characters or numbers Last Name This field is mandatory. Name should contain only letters and no special characters or numbers Email Address Phone This field is mandatory Please enter a valid mobile number. The mobile number must start with 0 and only contain numeric characters with no spaces. Job Title/ Position This field is mandatory 3 / 8 Customer Company Details Registered Company / Organisation This field is mandatory I am a representative of this organisation and have the authority to act on its behalf ABN (no spaces) Please ensure this ABN is not registered in SAP This field is mandatory Trading Name This field is mandatory Fleet Category (Please select) Businesses with 40+ vehicles with Capped Price Servicing Businesses with less than 40 vehicles Federal Government Local Government State Government Rental Taxi Not for profit This field is mandatory Do you want Pre-Paid Servicing when you purchase the vehicle (not available with Capped Price Servicing) Industry (Please select) Agriculture, Forestry and Fishing Mining Manufacturing Electricity, Gas, Water and Waste Services Construction Wholesale Trade Retail Trade Accommodation and Food Services Transport, Postal and Warehousing Information Media and Telecommunications Financial and Insurance Services Rental, Hiring and Real Estate Services Professional, scientific and technical services Administrative and Support Services (private) Public Administration and Safety (Government) Education and Training Health Care and Social Assistance Arts and Recreation Services Other Services (e.g. Repair and Maintenance; Personal and Other Services) This field is mandatory Location address Street Address Enter a physical address only (PO BOX is not allowed) This field is mandatory Please enable JavaScript to get the full experience of this website. Postal address (optional) Only provide if different to location address Company/Organisation Postal Address This field is mandatory Postal Suburb This field is mandatory Postal Postcode This field is mandatory Postal State (Please select) ACT NT NSW QLD SA TAS VIC WA 4 / 8 Your Total Fleet Mix What category of vehicles are in your fleet? (Please indicate the quantity by vehicle segment in the box) Small Passenger (optional) Med/Large Passenger (optional) Small SUV (optional) Large SUV (optional) Light Commercial (optional) Van (optional) Wagons (optional) Heavy Commercial (optional) Other (optional) In the next 12 months, approximately how many fleet vehicles will you look to replace or renew? (optional) 5 / 8 What brands are in your fleet? (Please indicate the quantity by vehicle brand in the box) Ford (optional) Holden (optional) Honda (optional) Hyundai (optional) Mazda (optional) Mitsubishi (optional) Nissan (optional) Subaru (optional) Toyota (optional) VW (optional) Other (optional) 6 / 8 Where is your fleet located? (Please indicate how many vehicles in each state or territory) ACT (optional) NSW (optional) NT (optional) QLD (optional) SA (optional) TAS (optional) VIC (optional) WA (optional) 7 / 8 Method of purchase within current fleet (Percentage split, total must add to 100%) Outright (%) (optional) Finance lease (%) (optional) Operating lease (%) (optional) Salary Packaged (%) (optional) Other (%) (optional) 8 / 8 Dealer Details Current Mitsubishi Dealer (if applicable) Current Fleet Management Organisation (if applicable) Message (optional) SUBMIT APPLICATION The registration process will generally be completed in 2 working days of your submission however, Mitsubishi Motors may need to contact you directly to confirm details. You will receive an email with your Mitsubishi Business Partner Number to unlock Fleet Discounts. I agree to the terms and conditions Please check the box above to agree to Mitsubishi Motors Terms & Conditions. By selecting this checkbox you agree to the terms in the Mitsubishi Privacy Policy. Mitsubishi collects your information for the purpose of processing and fulfilling your request and to send you marketing material. We may disclose your information to an authorised Mitsubishi dealer or our authorised agents, contractors or subcontractors for those purposes. Submit