Customer Profile

We are currently updating our customer's database and would greatly appreciate if you could take a few minutes to complete the following details. A small token of our appreciation in the form of a $20 cash voucher redeemable at our parts and accessories counter or our main workshop will be mailed to you on receipt of your completed form. All details are treated as confidential.

Car No. *

Full Name *

Street Address *

Postcode *

Postal Address *

Postcode *

Home Telephone

Mobile No

Work Telephone

Fax

Email

Date of Birth *

(dd/mm/yyyy)
Do you wish to receive email messages highlighting special offers at Jati Transport?
Yes
No
Are you receiving our Jati Journal and Mercedes Magazine annually?
Yes
No
Which daily newspapers and magazines do you read?

Which radio stations do you listen to?