MOBILITY CARD REQUEST MODULE
I, the undersigned, ____________________________________________________
Born in ____________________ on ________
Tax Code _________________________
Identity Card __________________________ Number ___________________________
Resident at (full address) _________________________________________ n. ______
Postal code________ Province_____ e-mail _______________________
Cell phone___________________
□
as physical person
□
in quality of_________________________________________________________________
The Company etc.
__________________________________________________
with legal address in ___________________________ street _________________n.
______
Postal code ________ Province _______ e-mail
_____________________________________________
Fiscal code________________________ VAT_________________________________
Owner of the following electric vehicles:
* autovehicle, LDV, moped, motorcycle, bicycle, …
ASKS FOR
The release of the Mobility Card to access Garda Uno SpA electric charging
stations
The service foresees an activation cost of 15,00 €. Electric charging is subordinate to an hourly tariff that includes both
charging and parking costs. For more info and updates you can visit the “Mobility” section of the website www.gardauno.it.
Date and place ________________ The user ______________________________
VEHICLE TYPE* MANUFACTURER MODEL NUMBER NUMBER
PLATE