Guardian Interlock Participant Enrolment Form

Guardian Interlock Systems Pty Ltd requires the following information to commence your Alcohol Interlock installation. Please complete the below and press the submit button. Please note that the Service Centre cannot commence the installation until this data is provided.

CLIENT INFORMATION

Please note all concession discount validity are check online with Services Australia after each service and discount will be charged back if found to be invalid. Rules apply to concession validity including maximum rate requirements in most states. Concession rules are set by each state government. Complete the link provided below after selecting Yes to have this information included on your account. Your concession card will need to be present at every service prior to the transaction commencing. We do not backdate concessions.
This detail is provided on the documentation received from your state road authority. Please note that VIC and WA programs are always set at 6 months initially.
Please select the state where you are having your install done
Next of Kin is the person you would consider your emergency contact eg. family member or close friend

INSTALLATION AND PRICING AGREEMENT

VEHICLE INFORMATION

REGISTERED OWNER DETAILS