Citex Fleet — Vehicle Information Form

Vehicle Information

From the vehicle itself

Unit # / Truck ID *

Year *

Make *

Model *

VIN * Also found on your registration card

License Plate *

State *

Color

Fuel Type *

Gasoline

Diesel

Hybrid

Electric

Documents & Expiration Dates

Check the glovebox

Registration Expiration *On registration card or windshield sticker

State Inspection Expiration *On the windshield inspection sticker

Insurance Provider *

Policy Number *

Insurance Expiration Date *

Maintenance & Condition

Read from dashboard today

Current Odometer (miles) *

Date of Last Oil Change

Date of Last Service

Known Issues, Damage or Repairs Needed?

Driver Information

Your personal details

Full Name *

Department *

Cell Phone *

Work Email *

Driver's License # *

License Expiration *

CDL (Commercial Driver's License)? *

Yes — I have a CDL

No — Standard license

Ready to submit?

Your response goes directly to your fleet manager.
All required fields must be filled in.

Submitted Successfully

Your fleet information has been received and emailed to your fleet manager. You're all set!