Pre-payment Dispute

Payment Disputes

"* (Required)" indicates required fields

Please select the pre-payment you are disputing:* (Required)

Enrollment

Partial Lease Payment

Before proceeding, you must read and agree to the Terms and Conditions:

Hidden

Serviced in Last 30 Days* (Required)

I confirm that my device has been serviced in the last 30 days

I understand that failure to service my device before submitting an Incident Report form may result in a rejection of my request.

Terms and Conditions* (Required)

I have read and agree to the Terms and Conditions of Service

Terms and Conditions of Service
The pre-payment dispute should only be completed by customers who have not installed a device, do not have a pending installation appointment, and have paid either an enrollment fee*, partial lease or the first month's lease.
If it is determined that a refund is to be issued, the refund will be issued in the form of a check delivered to the mailing address entered on this form.
RoadGuard Interlock holds the right to cancel a dispute if a chargeback was issued to the original form of payment.

State* (Required)

Account Holder Details

Full Legal Name* (Required)

First Last

Birthdate* (Required)

Driver's License #

Email* (Required)

Phone* (Required)

Mailing Address for Refund (if issued)

Street Address

Address Line 2

City

State

Zipcode

Reason for Dispute* (Required)

Please allow ten business days for an official response.

Refunds are determined on a case-by-case basis and are not guaranteed for all clients submitting the form below.

By submitting this form, you agree and consent for RoadGuard Interlock and its affiliates to use automated technology, including emails, calls, texts, and prerecorded messages, to contact you at the information provided. No purchase necessary; message and data rates may apply.

Pre-payment Dispute Form

This form below is to be used to dispute pre-payment fees associated with an installation appointment. Please note that calling, sending emails, or repeatedly resending the same dispute will delay the initial and entire request.

Payment Disputes

Account Holder Details

Please allow ten business days for an official response.

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