Mercedes-Benz Malaysia - Passenger Cars - Owner Registration

Please complete the form below.

Note that fields marked * are mandatory for us to process your request.

Title : *

(eg: Mr,Mrs,Tan Sri, Dato, etc..)


First Name : *


Last Name : *


Address : *

Postal Code : *

(eg: 50450)


Town / City :


State :


Country :

Gender : *

Male

Female


Email : *

Telephone (Off) :

(eg:6XX-XXXXXXXX)

Telephone (Hse) :

(eg:6XX-XXXXXXXX)

Mobile : *

(eg:6XXX-XXXXXXX)

Preferred Contact *

House	Office
Mobile


Car Model :


VIN/Chassis No *


Vehicle Registration No


Date of Registration *


Which dealer did you visit to purchase your vehicle?

Do you own other Mercedes-Benz vehicle? *

Yes


If yes, which model?

Do you service & repair your vehicle at MB authorised service centres? *

Yes


If yes, which service centre do you visit?