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Smart Start Incident Report Form

Use this form to request a credit or reimbursement of lockout fees, or to request a credit or reimbursement of tow charges (receipt required).

Please allow between five to seven 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.

Before proceeding, you must read and agree to the Terms and Conditions for the incident report.*

Terms and Conditions*
- I have read and agree to the Terms of Service
Disclosure of Terms and Conditions

The Incident Report form, gives you the client, an opportunity to explain the circumstances surrounding an event with your Ignition Interlock Device. Please understand your monitoring authority oversees the ignition interlock program and your state certifies all Ignition Interlock Devices.

A violation reset condition can be caused by the following events:
- Ingested Alcohol
- Mouth Contaminate – Eating or drinking while taking a required breath test
- Skipped or Missed Random Tests
- Service Lockout – Missed appointment
If your violation reset condition or service lockout was caused by one of the above events a refund will not be issued.

Credits will not be issued when the violation is found to be user error; such as skipped or missed random tests, eating or drinking while taking a test and all violations caused by ingested alcohol. There are limited exceptions to this rule.

A certified Ignition Interlock Device must enter into a violation reset when the restricted operator has:
- Recorded a random test failure;
- Disconnected the control head after start up;
- Failed to submit to a random retest;
- Failed to have the Ignition Interlock Device serviced within the time period described in the regulations of the state.
If you feel that your incident is reviewable after reading the above disclosure please complete the following Incident Report form.
State*
Please Complete this Form
Full Legal Name*
First Last
Birthdate*
Date Format: MM slash DD slash YYYY
Driver's License #*
Email*
Phone*
Date of Incident*
Date Format: MM slash DD slash YYYY
Time of Incident*

: HH

MM
Preferred Method of Contact
Detailed Description of the Incident*
Receipts (optional)

Drop files here or

Accepted file types: jpeg, jpg, png, pdf, doc, docx, xls, xlsx.
Comments
This field is for validation purposes and should be left unchanged.

Smart Start Incident Report Form

Please allow between five to seven business days for an official response.

Disclosure of Terms and Conditions

Please Complete this Form

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Smart Start Incident Report Form

Please allow between five to seven business days for an official response.

Disclosure of Terms and Conditions

Please Complete this Form

Device Types

Locations

Customer Support

Company Information

Contact Information

Privacy Links