Service Agreement

We require a completed Service Agreement from your recent Alcohol Interlock installation. Please complete the below and press the submit button. 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

Participant Name *

First

Last

Address *

Address Line 1

City

State / Province / Region

Postal Code

Mobile Number *

Date of Birth *

Driver Licence Number *

Vehicle Information

Vehicle Registration *

Vehicle Details Acknowledgement *

I acknowledge that my alcohol interlock is installed on the above provided registration and vehicle details have been provided to the service centre when install completed.

Service Agreement Introduction *

This Service Agreement including the Terms and Conditions and Fees Schedule (provided separately), forms the Interlock Driver Contract (IDC) between the client named above and Guardian Interlock Systems Australasia Pty Limited (Guardian) for the provision of services during the client’s participation in the interlock program.

Fees and Charges *

FEES AND CHARGES: The client agrees to pay all fees and charges arising under this Contract in accordance with the Terms and Conditions. Client acknowledges receipt of Guardian’s current Fee Schedule and understands that they may be eligible to concession subject to the rules of the Program. If eligible, a discount will be provided on production of a valid concession card at each service and a signed Centrelink eServices Confirmation form or Centrelink Income Statement.

LOSS PROTECTION PLAN (OPTIONAL) *

ACCEPT
DECLINE

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.

TERM *

TERM: The IDC shall remain in effect until above specified end of program date unless terminated earlier as provided herein, or the program is extended, provided in any event that Client’s obligations hereunder shall continue in full force and effect until the Equipment has been returned to Guardian (or its agents) in good condition subject only to reasonable wear and tear, and all fees and charges paid in full.

AUTHORISATION *

AUTHORISATION: Client authorises and directs Guardian, its agents, employees and/or contractors, to supply the products and/or services described herein, and it in connection therewith, to carry out any work on the Vehicle that is considered necessary or advisable during their participation in the Program. It is expressly acknowledged and agreed that all such work shall be deemed to be in pursuance of, and shall be subject to the IDC. Client also agrees to return the Vehicle for scheduled servicing on the dates advised. Client further authorises Guardian or its agents to recover Interlock equipment from my vehicle if my payments become in arrears or if the vehicle has been impounded.

ACKNOWLEDGEMENT *

ACKNOWLEDGMENT: Client hereby authorises Guardian to provide to the relevant Road Traffic Authority (RTA) your personal information and information on any other user of this device. This information may be disclosed to driver licensing and vehicle registration authorities, law enforcement agencies or other Government agencies that may require it by law. You have a right to access or correct your personal information in accordance with the provisions of the relevant privacy legislation. The Client agrees that Guardian may use and transfer personal information to an overseas database for the purpose of administration of the Program. I, the Client, hereby acknowledge that prior to submitting this form I have read and accept the Contract, including the Terms and Conditions found in the User Instructions. I acknowledge that I may be contacted via Telephone, SMS, Email or other electronic methods in regard to elements of the AIS.

Declaration *

I, the abovementioned participant, confirm that by submitting this form I have accepted the above service agreement terms and confirm I have provided the correct details above.

Declaration Date *