Sens-O-Lock | Addition of Loss Protection Form | New York Ignition Interlocks | New York Ignition Interlock Device | New York Ignition Interlock Provider

Addition of Loss Protection Form

Please complete and sign this form. If you have any questions, you may contact us.

Addition of Loss Protection Authorization*
- I have requested that Loss Protection be added to my existing lease agreement with Sens-O-Lock of America and agree to the terms listed below.
In the event the Equipment is lost, stolen or damaged in an accident, the Lessee shall pay the sum of $1,995.00 for FR9000 and $2,395 for WC9000 to replace the equipment or necessary repair fees and shall continue to make the monthly payments due hereunder. Lessee may obtain loss protection under the Loss Protection Plan for an additional monthly cost of $8.00. This loss protection will cover the system/device replacement cost less a $200.00 deductible fee. A police report must be filed and submitted to Lessor if the system is stolen or damaged resulting from an accident.

The loss protection will become effective upon my next payment date after the return of this signed Addendum B.
Customer Signature*
Date*
MM slash DD slash YYYY
Customer Printed Name*
Email*
Phone*
Consent*
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