Re-Activation of ADA – Welcome to Autosweep RFID

NOTE: APPLICABLE TO EXISTING ADA ENROLLEES ONLY

Important Note: This is to authorize Citra Metro Manila Tollways Corporation (“CMMTC”) and its Authorized Credit Card Bank Host (“Provider”), to charge my Credit Card for the replenishment of my RFID Account in accordance with the selected mode and the credit card information as provided below:
Date *
Account Name *
Account No. *
Plate Number *
Contact No. *
Email Address *
Credit Card No. *
Credit Card Type *
Expiry Date *
Bank Issuer *
Replenishment Amount *
Theshold *
Upload Photocopy of Credit Card (Front Only) *
Upload (1) One Valid I.D. *
Credit Card Authority To Charge Form *
Please check the boxes below to confirm request... *
I'm requesting for the enrollment/re-activation of my Auto Debit Arrangement (ADA)I hereby certify that the information provided is true and correct.