Event Inquiry Request

Please allow, at least, 30 business days for an official response.

Select the type of request below:

Reimbursement Requests

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

Reimbursement requests must be submitted within 30 days of the incident. Reimbursements are determined on a case-by-case basis and are not guaranteed by submitting this form. Before proceeding, you must read and agree to the Terms and Conditions for the incident report.*

Disputing Device Data / Reports

Need to dispute an extension, violation, or non-compliance letter? Submit your information and attach a copy of the full letter along with any supporting documents (such as receipts). Please also include a brief summary of what occurred during the reporting period.

Consent*
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 Early Recall 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 Early Recall 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 Early Recall when the restricted operator has:
- Recorded a random test failure;
- Disconnected the control handset 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*
ZIP Code*
Full Legal Name*
First Last
Birthdate*
MM slash DD slash YYYY
Driver's License #*
Email*
Phone*
Type of Request*
Date of Incident*
MM slash DD slash YYYY
Time*

: Hours

Minutes

AM/PM
Preferred Method of Contact*
Detailed Description of the Incident*
Receipts (optional)
Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 50 MB, Max. files: 5.
You may attach up to 5 files in either jpg, png, or pdf formats.