Form 1502 "Service Center Provider Application - Ignition Interlock Device Program" - South Carolina

What Is Form 1502?

This is a legal form that was released by the South Carolina Department of Probation, Parole and Pardon Services - a government authority operating within South Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 6, 2016;
  • The latest edition provided by the South Carolina Department of Probation, Parole and Pardon Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 1502 by clicking the link below or browse more documents and templates provided by the South Carolina Department of Probation, Parole and Pardon Services.

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Download Form 1502 "Service Center Provider Application - Ignition Interlock Device Program" - South Carolina

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South Carolina Department of Probation, Parole & Pardon Services
Ignition Interlock Device Program
Service Center Provider Application
Service Center Provider Information
Service Center Provider Name:
Manufacturer:
Contact Person and Title:
Physical Address:
Mailing Address
(If Different):
Phone Number:
Fax Number:
E-mail Address:
Website:
Type of Business Performed:
Automotive
Car Audio/Stereo
Other:
Service Center Provider Hours of Operation (Monday – Sunday):
Opening at
and Closing at
Planned Closures (Month and Day):
Employee Information
Please provide a technician application for each technician or any personnel who will assist with the calibration or monthly
monitoring reports.
How many technicians will be involved with the installation of the ignition interlock device? ___________
How many employees will be involved with servicing the participants of the Ignition Interlock Device Program? Please list the
name of each employee. __________
1.
2.
3.
4.
I certify, under penalty of perjury under the laws of the state of South Carolina, that the foregoing and all included documents are true and correct.
Signature__________________________________________________
Date __________________________
Do not write below this line.
☐Approved
☐Denied
Date
Reviewed By / Title
Authorization Number
Submitted by:
Title:
Date:
Form 1501 (Template)
12/6/2016
South Carolina Department of Probation, Parole & Pardon Services
Ignition Interlock Device Program
Service Center Provider Application
Service Center Provider Information
Service Center Provider Name:
Manufacturer:
Contact Person and Title:
Physical Address:
Mailing Address
(If Different):
Phone Number:
Fax Number:
E-mail Address:
Website:
Type of Business Performed:
Automotive
Car Audio/Stereo
Other:
Service Center Provider Hours of Operation (Monday – Sunday):
Opening at
and Closing at
Planned Closures (Month and Day):
Employee Information
Please provide a technician application for each technician or any personnel who will assist with the calibration or monthly
monitoring reports.
How many technicians will be involved with the installation of the ignition interlock device? ___________
How many employees will be involved with servicing the participants of the Ignition Interlock Device Program? Please list the
name of each employee. __________
1.
2.
3.
4.
I certify, under penalty of perjury under the laws of the state of South Carolina, that the foregoing and all included documents are true and correct.
Signature__________________________________________________
Date __________________________
Do not write below this line.
☐Approved
☐Denied
Date
Reviewed By / Title
Authorization Number
Submitted by:
Title:
Date:
Form 1501 (Template)
12/6/2016