HumberTAG APPLICATION FORMHUMBERBRIDGEBOARD

HumberTAGSMARTER QUICKER

HUMBERTAG ACCOUNT APPLICATION FORM

Section 1Your Details (please print clearly in block capitals)

Low balance warning amount

Online Email Paper

I confirm that I have read, understood and accept the HumberTAG Terms and ConditionsBy providing your details you agree that we may contact you regarding your HumberTAG account.

Signature Date

When your account balance falls below this level you will receive a notification requesting that you add funds

Low balance warning - please state how you would like to receive a notification (pleasetick 1 option)

Email SMS

Please note that by ticking 1 of these options you agree to receiving notifications from us

Please select how you would like to monitor your account by choosing 1 of the following options: Online – This allows you to download your own statementsEmail – A statement will be emailed to you each monthPaper – A statement will be sent via the post each month (please note this option carries a £3.50 monthly fee)

HUMBERTAG ACCOUNT APPLICATION FORM

Section 2Your TAGS (please print clearly using block capitals)

Vehicle classification and toll price guide*

*Please see www.humberbridge.co.uk for more detailed descriptions on vehicle classifications

Toll-cash price Toll-TAG price

2- axle light(eg, car, van)

2- axle heavy(eg, over 3.5 tons GVW)

Multi-axle(eg, over 7.5 tons GVW)

£1.50

£4.00

£12.00

£1.35

£3.60

£10.80

Using the table below, please enter the registration numbers for all the vehicles you want to add to your account. Please note that each vehicle listed will require a tag (£15 deposit each) which is specific to your vehicle registration number.

Indicate the classification for each vehicle, using the guide above. There are 2 types of tag brackets – one for angled windscreens (most cars and light vehicles) and one for vertical windscreens (most heavy goods vehicles).

Vehicle registraton 2-axle light 2-axle heavy Multi-axle Windscreen DepositExample only Example only Example only Example only Example only Example only Example only Example only Example only Example only Example only Example only Example only Example onlyExample only Example only Example only Example only Example only Example only Example only

angled £15

INITIAL CREDIT(The minimum credit needed to open an account is £15)

TOTAL DUE(All the deposits add the initial credit)

HUMBERTAG ACCOUNT APPLICATION FORM

Section 3Your initial payment (please print clearly using block capitals)

CHEQUE: If paying by cheque, please make it payable to Humber Bridge Board and write “ New HumberTAG account ” on the reverse. Please send your cheque and completed application form to the address below.

CARD: To make your initial payment by credit or debit card, complete the form below.

Please select a card provider

Mastercard Visa Visa Debit Solo Maestro

Card number

Name on card

Expiry Date Issue Number(if available)

I authorise you to debit my credit card/debit card account with the amount shown

Signature Date

Section 4Your future payments

ONLINE: You can log intoyour account and top up using your credit or debit card.

BY POST: Send us acheque to the address below.Make it payable to Humber Bridge Board and write youraccount number on thereverse.

IN PERSON: Pop in to theaddress below and top upusing card, cash, or cheque.You can also ring us on 01482 647162 to top up by card.

Please email your completed application form to admin@humbertag.com. We aim to process your tag within 14 days.

HumberTAG Account, Humber Bridge Board, Ferriby Road, Hessle, East Yorkshire, HU13 0JG