Payment Disputes

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Please select the pre-payment you are disputing:* (Required)
Before proceeding, you must read and agree to the Terms and Conditions:
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Serviced in Last 30 Days* (Required)
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)

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.

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.