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*Note:
Membership to this site is public. Once your account information has been submitted, you will be granted immediate access to the site. All fields marked with a red asterisk are required.
(
Note:
- Registration may take several seconds. Once you click the Register button please wait until the system responds.)
Password:
Enter your password.
Confirm Password:
Re-enter the password to confirm.
First Name:
Enter a first name.
Last Name:
Enter a last name.
Email Address:
Enter a valid email address.
Street Address:
Enter the street part of the address (PSC 123 BOX 10)
City:
Enter the city part of the address
State / Province:
Enter the region (state, province or county) part of the address
Postal Code:
Enter the Postal/Zip Code part of the address.
Home Telephone (w/Country Code): (+1 +81)
Enter the home telephone number to reach you.
Cell Telephone: (w/Country Code): (+1 +81)
Enter the cell telephone number to reach you.
Country Code:
Enter Country Code For Contact Number
How Long Have You Been Driving in Japan?
Select how long have you been Driving in Japan.
<Not Specified>
1 to 3 Years in Japan
4 to 7 Years in Japan
8 to 10 Years in Japan
Less Than 1 Year in Japan
Over 10 Years in Japan
Estimated Tolls Monthly:
Input the amount of Tolls you estimate that you will charge monthly using your ETC card.
Birth Date:
Enter Birth Date
Status
Select current status while living in Japan
<Not Specified>
Active Duty Military
Family Dependent
Government Civilian
Government Contractor
MOFA
Other In Japan
Current Military Base:
Input the name of the military base, or location that you work in Japan
Employer
Input your Employer, example: US NAVY, US ARMY, US MARINES, US AIRFORCE, TOKYO EMBASSY
Command
Enter US Govt Command or Location you support
Work Telephone: (w/Country Code): (+1 +81)
Please include your work phone in case we have to get in touch with you.
Work Address
Please include the full address for your work.
Work Email
Please include your work email address or your SPONSORS work email address.
PRD:
Input the date your planning to leave Japan
Visa Status
It is required that all individuals that obtain a Japan ETC Card from our company have either a SOFA status or MOFA status. We are currently not accepting any other clients, with other visas.
<Not Specified>
MOFA Status
Other Status
Retired Military
SOFA Status
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