Payment Arrangement Agreement Please enable JavaScript in your browser to complete this form.Guardian Interlock Systems Australasia Pty Ltd has emailed you a summary of your current amount owing and the payment schedule. Please complete the below form to confirm you agree to this schedule.Participant Name *FirstLastDate of Birth *Driver Licence Number *Email address *Phone *Total Debt to be Paid *Enter amount specified in the provided documentation in the “Current arrears” sectionPayment Schedule Amount *Enter amount specified to be paid each periodPayment Schedule Rate * WeeklyFortnightlyMonthlyPayment Schedule Start Date *Are you paying a Security Deposit, Payment Arrangement or both ?Security Deposit OnlyPayment ArrangementPayment Arrangement including Security DepositSECURITY Deposits – BSB 082 135 Account Number 84 169 1600All payments must be made by Visa/Master Card over the phone to Guardian Head Office OR by direct deposit into the relevant bank accountParticipant State – select to provide bank account details NSW/ACTNTQLDSATASVICWANSW/ACT – BSB 082 135 Account Number 56 709 1919All payments must be made by Visa/Master Card over the phone to Guardian Head Office OR by direct deposit into the relevant State bank accountNT – BSB 082 135 Account Number 15 916 7873All payments must be made by Visa/Master Card over the phone to Guardian Head Office OR by direct deposit into the relevant State bank accountQLD – BSB 082 167 Account Number 18 234 5930All payments must be made by Visa/Master Card over the phone to Guardian Head Office OR by direct deposit into the relevant State bank accountSA – BSB 082 135 Account Number 53 368 8784All payments must be made by Visa/Master Card over the phone to Guardian Head Office OR by direct deposit into the relevant State bank accountTAS – BSB 082 309 Account Number 94 620 6173All payments must be made by Visa/Master Card over the phone to Guardian Head Office OR by direct deposit into the relevant State bank accountVIC – BSB 082 135 Account Number 55 667 5230All payments must be made by Visa/Master Card over the phone to Guardian Head Office OR by direct deposit into the relevant State bank accountWA – BSB 082 309 Account Number 23 131 5640All payments must be made by Visa/Master Card over the phone to Guardian Head Office OR by direct deposit into the relevant State bank accountDeclaration *I, the abovementioned participant, confirm that by submitting this form I acknowledge that I ACCEPT and agree to the outlined payment plan. I understand that if I fail to follow this payment plan my debt will be transferred to a debt collection agency for follow up which will result in additional fees being added to my debt to cover the cost of the debt collection agency fees.Please note if you have any queries regarding any of these items please contact Guardian on 1300 881 005 to discuss.Declaration Date *Submit
