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Toll Collect: User registration

User registration
Personal details Services Payment Check info Print

User Data

Company name* Foreign legal form* Register Court* Commercial register number** VAT Registration Number (VAT. Reg. No.)* Value added tax number*

abc Foreign legal form 123456 abc1234 91 09876 12345

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Company address

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House number, street* PO Box Post Code* City* Country* Telephone* Fax Company e-mail I authorise Toll Collect GmbH to send information to this company e-mail address. edit

1/2 560035 bangalore India +90 1234564 4568123 -

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Contact

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Surname Forename Telephone Fax edit

vrrrr erddd -

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Toll Collect: User registration

Internet log-on

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Please mark this box if you do not wish to make use of Internet log-on. edit

OK

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How would you like to receive your toll statement?

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By e-mail as a printable file (PDF)

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How would you like to receive your itemised journey list?

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By e-mail as a printable file (PDF)

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Invoice e-mail address

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Same as company e-mail Invoice e-mail address* edit

abc123@gmail.com

Payment method

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Settlement by credit account Direct debit prepaid service I do not want to be registered for settlement by credit account until the selected payment method is established. The registration of my company will be completed when all required information is provided by me and by my chosen payment service provider. edit
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Toll Collect: User registration

Declaration of consent

I hereby confirm that all the information I have provided is accurate and complete. Toll Collect GmbH will store, process and use your data for contract-related purposes. I accept the Toll Collect GmbH General Standard Terms and Conditions. The General Standard Terms and Conditions are posted on the Internet at www.toll-collect.de or can be obtained from Toll Collect GmbH (Calls from within Germany: 0800 222 2628*. Calls from outside Germany: 008000 222 2628*). *free call, mobile phone charges may vary I agree* Place, date* 62 44

*Required fields

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