Mileage Minders

Contact information
Name:
Company Name:
Mailing address: City, Prov. Postal Code:
Phone:
Mobile Number:
Fax Number:
Email Address:
Reminder Choices
How would you like us to contact you for reminders in order of choice?
Mobile Phone:	One Two Three Four
Land Line:	One Two Three Four
Fax:	One Two Three Four
Email:	One Two Three Four
How long would you like us to wait before we remind you of your mileage? You can indicate, 1 day, 1 week or whatever your preference is.
Enter the wait time before we we remind you  about your mileage.
Do you have standard days off that we should take into account before reminding you?  If so please indicate below.
Please enter days off or  other scheduling comments.
If you have set dates you would like to be reminded of please enter below, this can include birthdays, anniversaries or any date you choose.
Please enter dates that you would like to be reminded of.
Mileage Log Choices
When would you like your mileage logs delivered to you?
Please Choose:	Daily Weekly Monthly Yearly
If you have a different choice or comment enter it here.
How would you like your mileage logs delivered to you?
Delivery Choice:	Email Fax Postal Service
Creating Your Log
What would you like to see on your mileage log?  We can make additional changes later if you miss something.   As an example, on one vehicle I need to break down my husbands business, my business, personal and medical mileage so my log contains MSJ, MM, Personal and Medical.   If you have multiple vehicles you may choose a single log for all vehicles or a log per vehicle.  Foster parents may choose one log per child or a log containing all children.  Please enter your preferences below
Please enter  your preferences here:
Other Information If there is any other information that you feel is pertinent to satisfying your mileage needs please enter it here.
Please enter  other info here:

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