Service Agreement

At your recent interlock installation we did not receive a completed Service Agreement. Please complete the below to rectify this. Please note that if this form is not provided you may experience delays at your next service. We appreciate your assistance with this matter.

Client Information

Vehicle Information

The Client acknowledges and accepts financial responsibility for any damage to, or loss of, the System, however caused, provided that upon payment of the Loss Protection Plan (LPP) fee, the Client’s financial responsibility loss of the System shall be limited to the Loss Protection liability limit amount shown in the Terms and Conditions & Fee Schedule. Notwithstanding the foregoing, purchase of the LPP shall not limit the Client’s financial responsibility for damage to, or loss of, the System caused by a willful act or omission on the part of the Client or other permitted users of the Vehicle. The Client must present a copy of a Police report, along with any other evidence of loss, and pay the Liability Limit within 72 hours of loss. If the Client declines the LPP, the Client is responsible for payment of complete loss or any part of the System, this cost is outlined in the Fee Schedule. The LPP does not cover outstanding lease fees. Please indicate if you wish to accept of decline by initialing in the area below.
Please enter the date your program is due to be completed. Note: The contract will remain in place until the initial program end date, any program extensions are not included in the contract period.