Driving Pays Sign Up Form
We will ask you some preliminary questions here. You may be asked to provide more information about your driving habits as well as proof of car insurance and a valid driver's license. Please note that you can only sign up for a car that you own, lease or finance.
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| User Name : |
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Password : |
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| First Name : |
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Last Name : |
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| E-mail : |
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Phone : |
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| Gender : |
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D.O.B. : |
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| Address : |
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City : |
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| Province : |
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Postal Code : |
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| Do you drive to work? |
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Occupation : |
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| Work City : |
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Work Province : |
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| Work Post Code : |
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Usual work hours? |
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On average, how many days/week do you work ? |
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Check box if your job requires you to drive during your workday. |
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Check box if at WORK you park in a spot that is visible to pedestrian traffic
(i.e. on the street, street level garage) |
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Check box if at HOME you park in a spot that is visible to pedestrian traffic
(i.e. on the street, street level garage) |
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| You drive about : |
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You drive about : |
km/day. |
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Places you go with your vehicle often? (i.e. Yorkdale Mall) |
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| Vehicle Year : |
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Make (i.e. BMW) : |
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| Model (i.e. 328i) : |
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Body Style : |
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| Vehicle Color : |
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Vehicle Condition : |
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| Preferred sticker locations |
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How did you hear about us? |
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| Please write details of how you heard about us. (Referal's first and last names/specific website name/specific newspaper/specific radio station) |
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| Apart from corporate clients we also work with not-for-profit organizations.
Check box if you would be willing to put a sticker with a social advertisement on your car for free. |
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| Anything else you want to let us know right now? |
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| Please type what you see in the image below: |
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