Copec Voltex - Registration

CHOOSE THE PLAN THAT'S RIGHT FOR YOU

We currently offer the following charging plans:

ACCOUNT DETAILS

First Name *

Last Name *

Email Address (Username) *

Mobile Phone *

Language *

Gender

Billing & Mailing Address

Address *

City *

State *

County *

Postcode

Country *

Send mail to the same address

Mailing Address

Address *

City *

State *

County

Postcode

Country *

Eligibility information

We need to verify that you are eligible to charge with this plan, please enter your identifier below.

Your vehicle information

In order to serve you better, please enter your car type.

Make

Model

Year

Registration Number

Security

Password *

Password: Minimum 8 chars: with at least 1 number, 1 uppercase, 1 lowercase & 1 special character (!, @ ,# ...)

Confirm Password *

Confirm Password: Minimum 8 chars: with at least 1 number, 1 uppercase, 1 lowercase & 1 special character (!, @ ,# ...)

I would like to receive marketing updates via email or SMS or push notifications

PAYMENT METHOD

Full Name on the Card *

Card Number *

Expiration Date * /

CVV *

Pay as you go preferences

You can always change plan preferences later on

Enter the amount of credit for your account *

An initial amount of will be charged as prepaid credit on your account

Automatically top up

Automatically add

When balance is less than