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[ TOTAL機油 U-CAR試用招募活動]報名表
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U-CAR帳號
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車主姓名
*
Your answer
試用者姓名
*
請填寫將車子開去更換機油的人名
Your answer
試用者連絡電話
*
請填寫手機號碼：範例0900-000000
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出生年月日
*
請填寫西元出生年月日：範例1900/01/01
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試用者連絡地址
*
(請註明郵遞區號)
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試用者連絡Email
*
Your answer
您目前使用的車款
*
例:sentra、altis
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您目前使用車款的車號
*
請填寫車牌號碼(例：ABC-1234)
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您目前使用車款的排氣量
*
請填寫為幾CC的車子(例：2000CC)
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愛車出廠年份
*
請填寫西元年
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請選出更換的地區
*
填寫時請注意，只能填寫一個更換機油之縣市！(例：台北市)
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