Roadside Assistance - Fleet Management Form

Company name*

WEX Motorpass account number*

ABN*

Account holder's full name*

Email Address*

Consent*

Use the form below to add one, or multiple vehicles to your application

WEX Motorpass card no.*

Payment plan*

Vehicle rego*

Old vehicle rego*

New vehicle rego

(Required if updating a vehicle rego)

Vehicle make*

Vehicle model*

Year of manufacture*

Vehicle license state*

Vehicle Identification No.*

Weight (tonnes)*

*Please note, the price per vehicle will vary depending on the vehicle weight. Please refer to wexinc.com/motorpass for the details on pricing.