Driver Registration

Section 1: You and your driving (all applicable questions are compulsory)

Given Names*     

Surname*             

Address*                

City*                    

Postcode*            

Work Address     

Work Postcode* 

Phone*                

Email*                

Age*                

State*                     ---Please Select--- NSW ACT VIC QLD NT WA SA

       Sex*                    -----Please Select---- Male Female

If you where referred to us by a member of the referral program, please enter the reference number:

Are you prepared to wrap your existing car in an advertisement?*

 Yes        No       

What is the make, model and year of your car?*

Make    Model  Year

How many kilometres do you drive per month?*

  ---Please select--- Less than 800 1000 1300 1500 2000 2000+

How much time do you spend in your car per day?*

  ---Please select--- Less than 1 1-2 2-3 3-4 4 or more

What time of day do you drive most? (choose two)*

  ---Please select--- 6:00am-8:00am 8:00am-10:00am 10:00am-12:00pm 1:00pm-3:00pm 3:00pm-5:00pm 5:00pm-7:00pm 7:00pm-9:00pm 9:00pm-11:00pm                                                 ---Please select--- 6:00am-8:00am 8:00am-10:00am 10:00am-12:00pm 1:00pm-3:00pm 3:00pm-5:00pm 5:00pm-7:00pm 7:00pm-9:00pm 9:00pm-11:00pm

Where do you mostly park?*

  ---Please Select--- Parking lot Street Personal Garage Public Garage Personal Driveway

Work Address  *                                          Work Postcode

School/University Location

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Section 2: Your other activities (optional)

How Often do you shop?

  ---Please select--- N/A 1-2 3-4 5-6 6+     

Where do you mainly shop?   

How often do you drive when you go out to your nightlife?

  ---Please Select--- Never 1-2 2-3 3-4 4+

Nightlife Location?

How often do you go to concerts a year?

  ---Please Select?--- Less than 1 1-2 3-4 5-6 7+

If so, who do you go to see? Please describe any festivals, bands and singers.

How often do you go to sporting events per year?

  ---Please Select?--- Less than 1 1-3 4-6 7-9 10-12 12+

If so, please describe what sports and teams you watch, as well as any season passes held etc.

Is there anything else you would like to add about your driving habits that may increase the benefit you provide to advertisers:

Section 3: Driving Offences (Compulsory)

Have you had any driving offences bought against you in the past 2 years? Including speeding, negligent driving, disobeying road rules etc.*

 Yes      No

If Yes please explain the circumstances and offence. Please note that having offences does not necessarily mean you will be excluded from the program.

Where did you hear about us?*                  If other, please provide details?

  ---Please Select?--- Word of Mouth Vehicle Advertisement Flyer Poster Newspaper Money Magazine Google Facebook web Other                          

By submitting this form you agree to our driver conditions and privacy policy.

I agree to the terms and conditions