4 Year Installation Fee Offer

Participants who are required to be on the interlock program for 4 (+) years, qualify for Guardian’s offer to take up One free standard install

Offer cannot be redeemed for cash. Participants will be liable to pay any additional fees in excess of this offer. Offer cannot be redeemed by anyone other than the Participant.

Participant Name *

First

Last

Date of Birth *

Driver Licence Number *

Acceptance – Free Standard Installation

I, the abovementioned participant, confirm that by submitting this form I acknowledge that I understand the conditions of the benefit given by Guardian Interlock Systems. As a 4 (+) year participant, I am eligible for one (1) free standard installation*. I understand that if early termination occurs, the cost of the benefit then becomes an outstanding amount on my account to be paid as instructed. I understand that early termination fees may apply on early removal and I am not exempt from these fees. I understand that the free standard install will be provided as a credit on my account after the installation has been completed and acceptance/documentation provided.

Acceptance – Documentation requirement *

I, the abovementioned participant, understand that I must provide proof of the program duration by submitting below a copy of the government paperwork which provides this information.

Declaration Date *

Proof of Program Duration *

Click or drag files to this area to upload. You can upload up to 4 files.

Please load the correspondence received from the state road authority which indicates the alcohol interlock program or scheme duration.