Company information Company name (required) Address 1 (required) Post Code (required) City (required) Country (required) Telephone (required)[telephone* telephone_company initialCountry:be] EU VAT Number (required) Parking information Who are you?A dedicated truck parking areaA service stationA certified truck parking area Name Truck Stop (required) Address 1 (required) Post Code (required) City (required) Country (required) Telephone (required)[telephone* telephone_parking initialCountry:be] GPS Data : latitude, longitude (example N 44 10.411, E 5 16.699 or N 44 10 24.7, E 5 16 41.9)(required) . UTM coordinates (example 31T 682130 4893670 or 44.17352, 5.27831) Name of Highway Exit Number Parking apps used NoneTruckparking EuropeBoschSnap How many truck parking spots do you have? (required) Contact information Please select MrMs. Title First Name (required) Last Name (required) Phone (required) [telephone* telephone_contact initialCountry:be] Mobile phone (required) [telephone* telephone_mobile_contact initialCountry:be] Email (required) Site Manager contact information Please select MrMs. Title First Name (required) Last Name (required) Phone (required) [telephone telephone-manager initialCountry:be] Mobile phone (required) [telephone telephone_mobilemanager initialCountry:be] Email (required) Website Social media Facebook url LinkedIn url Twitter url Instagram url Service level (mandatory for EU-STANDARD) In order to be awarded an audit certificate for any of the four security levels (BRONZE, SILVER, GOLD, PLATINUM), the mandatory service level must be met. Please select which services your parking area provides. •Toilets for men and women available and working •Showers for men and women available and working •Toilets are cleaned and checked at regular intervals •Water taps available and working •Waste bins available onsite •Clear signs that promote safe traffic at the TPA •Emergency contacts displayed at the TPA •Snacks and drinks are available for purchase 24/7 [checkbox EU-STANDARD09"] •Electricity connection possibility for personal use •Washing facilities are cleaned and checked at regular intervals (with cleaning schedule) Parking Facilities • Safe Traffic (even surface) • Separate parking for HGVs • Refrigerated vehicles accepted • Separate parking for refrigerated vehicles • Dangerous Goods vehicles accepted • Electric cooling charging facilities [checkbox EParking Facilities06) "• Separate parking for dangerous goods"] • Additional unsecured parking spaces • Handicapped parking • Reservation system • Electricity for trucks • Truck Wash • Snow-Ice removal equipment • Indication of services and opening times Fuel Facilities • Fuel Station (not 24/7) • Fuel Station (24/7) • Diesel • AdBlue • LPG • LNG • CNG Food and Shop Facilities • Restaurant (with larger choice than snack bar) • Snack Bar • Small Supermarket • Vending machine for food and beverages • Spare parts shop • First Aid-Pharmacy • COVID-19 equipment Office Facilities • Office Centre • Meeting Rooms • Fax-Copier General Facilities • Emergency Assistance • Wifi / Internet • Cash Dispenser • Currency Exchange • Sleeping Facilities • Laundry • Shelter against rain or sun • Picnic Table • Solar Panels • Leisure Facilities • Television Room • Fitness Room • Steam Bath Eco friendly Facilities • Solar panels • Green electric cooling charging facilities • Charging stations Gas station •Aral •Shell •TEXACO •OnTurtle •TOTAL •ESSO •SMART DIESEL •STAR •GULF •CIRCLEK •Sinclair •LUKOIL •Q8 •REPSOL •BP •FUEL SAVE •ORLEN •Independent Payment methods Creditcards •Visa •Maestro •American Express •Diners Club •Electronic Cash •Mastercard •Bancomat •Autobahn-Rabatt-Karte •LOG PAY Fuel Cards •DKV Tankcard •Esso Tankcard •UTA Tankcard •BP Routex •Shellcard •Total Tank Card •OnTurtle DieselCard •Texaco Card •Smart Diesel Card •Circle K Routex •Network Fleet Card •EUROWAG •EDC Toll •Go-maut •Via Pass •Télépéage •LKW MAUT •Via Verde •Via Livre •VIA T mobe •Texaco Card •Eazy PAss •Etarif •SkyToll •TELEPASS Other payment methods •Pay Pal •Revolut etc I declare that the information provided by me on the above form is true and correct to the best of my knowledge and belief.