Incident Report

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).

"* (required)" indicates required fields

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This field is for validation purposes and should be left unchanged.

Before proceeding, you must read and agree to the Terms and Conditions of Service for the Incident Report:

Serviced in Last 30 Days* (required)

I confirm that my device has been serviced in the last 30 days. 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 Incident Report form gives you, the client, an opportunity to explain the circumstances surrounding an event with your Intelligent Speed Assistance device. Please understand your state authority oversees the Intelligent Speed Assistance program and your state certifies all Intelligent Speed Assistance devices.

A violation recall condition can be caused by the following events:

Speed Exceedance Violation
Service Lockout – Missed appointment

If your violation 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. There are limited exceptions to this rule.

A certified Intelligent Speed Assistance device must enter into a violation recall when the restricted operator has:

Failed to have the Intelligent Speed Assistance 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.

I have read and agree to the Terms and Conditions of Service

State* (required)

Please Complete the Following Details

Full Legal Name* (required)

First Name Last Name

Birthdate* (required)

Driver's License #* (required)

Email* (required)

Phone* (required)

Date of Incident* (required)

Time of Incident* (required)

Preferred Method of Contact

Detailed Description of the Incident* (required)

Receipts

Drop files here or

Accepted file types: jpeg, jpg, png, pdf, doc, docx, xls, xlsx, Max. file size: 25 MB, Max. files: 5.

An official response will be available within 30 days.

Refunds are determined on a case-by-case basis and are not guaranteed for all clients submitting the form below.

Please allow ten 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.

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Please visit https://smartstartmn.com/support/support-ticket/ to submit a support ticket.