Please allow 2 business days to receive your response. Please ensure that all of the below information is accurate. Information that is incomplete, or not accurate, will cause delays in the processing of your appointment. All fields marked with an asterisk (*) are mandatory Are you a New Client or a Transitioning Client?*New participant to the programTransitioning participant from a different supplierNOTE: Transitioning clients currently have an Ignition Interlock device installed on their vehicle and are planning to transfer their program to Smart Start.Letter of Eligibility from SAAQ*Yes, I have it and I will bring it to my appointmentNo, I did not receive it yetWe cannot proceed with the creation of your file and you will not be able to submit this form. Please contact us upon receiving your Letter of Eligibility from the SAAQ.Do you have a removal appointment?*Yes, I have a removal appointment. See below.No, I do not have a removal appointmentRemoval Date* Date Format: YYYY dash MM dash DD Removal Time*Hour12356789101112 Minute000510152025303540455055 AMPMWe cannot proceed with the creation of your file and you will not be able to submit this form. Please contact us when your removal appointment has been scheduled.What is or what will be the condition of your driver’s licence?You will find this information on your driver’s licence (participant in transition) or on your eligibility letter from SAAQ (new participant)RestrictedCondition ICondition XCondition ICAPersonal InformationFirst Name*Middle NameLast Name*Date of Birth* Date Format: YYYY dash MM dash DD Telephone Number*Alternate Phone NumberCan we send you information and notifications via text message?* Yes, I authorize you to send me text messages Email Address* Driver's License Number*Emergency Contact Name*Emergency Phone Number*AddressStreet Address*City/Town*ProvinceQuébecAlbertaBritish ColumbiaManitobaOntarioSaskatchewanCountryPostal Code*InstallationPreferred Service Centre*-- Select --AB, Barrhead - 4921 50 AveAB, Brooks - 620 1st Avenue EastAB, Calgary - 4638 11 St NEAB, Calgary - 113, 10555 48 St SEAB, Camrose - 3720 48 AvenueAB, Cold Lake - 5611 54 StreetAB, Drumheller - 801 S Railway AveAB, Edmonton - 2683 96 St NWAB, Edmonton - 17518 105 Ave NWAB, Fort Mackay - Fort McKay Industrial Park Lot 78AB, Fort McMurray - 330 MacKenzie BlvdAB, Grande Prairie - 11101 100 StAB, High Level - 10315 96 StAB, High River - 1008 20 ST SEAB, Hinton - 24503 East River RoadAB, Lethbridge - B 3015 12 Avenue NAB, Lloydminster - 5702, 50ave, Bay#4AB, Medicine Hat - 16 Strachan CRT S.E.AB, Peace River - Bay1, 8909 – 96 StreetAB, Provost - 5019 ,57TH AVEAB, Red Deer County - 108-172 Clearview DriveAB, Sherwood Park - Unit 120 2899 Broadmoor Blvd.AB, Slave Lake - 621 Main Street NEAB, Whitecourt - 3708 Kepler St.BC, 100 Mile House - 916 Alpine Ave.BC, Abbotsford - 2602 Mount Lehman RdBC, Burnaby - 5589 Byrne Road, Unit 131BC, Campbell River - 250 Dogwood St Unit 108BC, Castlegar - 1965 Columbia Ave., Unit #200BC, Chilliwack - 7677 Prest RoadBC, Courtenay - 2967 Kilpatrick AveBC, Cranbrook - 1617 Cranbrook St NBC, Dawson Creek - 741 Hwy 2BC, Fort Nelson - 4444-50th AveBC, Golden - 1025 10th Ave NBC, Kamloops - 745 Notre Dame DrBC, Kelowna - 1881 Harvey AveBC, Langley - 20111 Industrial Ave. Unit #101BC, Maple Ridge - 470 20170 Stewart CrescentBC, Nanaimo - 201 - 3300 Norwell DrBC, North Vancouver - 150 Pemberton Ave. NBC, Penticton - 2601 Skaha Lake Road Unit 101BC, Port Coquitlam - 222-1655 Broadway StBC, Prince George - 2591A Vance RoadBC, Prince Rupert - 601 3rd Ave WBC, Quesnel - 855 Rita RoadBC, Sechelt - 102-5520 Sechelt Inlet CresBC, Terrace - 4716 Keith AvenueBC, Vancouver - 8770 Ash StreetBC, Vernon - 3107 48th Ave Unit 200BC, Victoria - Unit 103 977 Langford PkwyBC, Westbank - 2180 Elk Rd Unit 200BC, Whistler - 1330 Alpha Lake RoadBC, Williams Lake - 1148 Broadway Ave SMB, Blumenort - 9 Centre AveMB, Brandon - 121-17th St NorthMB, Dauphin - 55 Keays StreetMB, Flin Flon - MB-10 AltMB, Thompson - 91a Kelsey BayMB, Winkler - 545 Cargill RoadMB, Winnipeg - UnitA 1420 Clarence AvenueMB, Winnipeg - 1200 Fife StreetMB, Winnipeg - 615 Mission StreetON, Barrie - 151 Tiffin StON, Brampton - 6A Tibury Ct. Unit #1ON, Brantford - 537 West StON, Carp - 107 Wescar LaneON, Chatham - 12 Indian Creek Rd EastON, Cornwall - 645 Cumberland StON, Dryden - 164 grand TrunkON, Gravenhurst - 451 Bethune DR NON, Hanover - 641 13th AveON, Kingston - 1093 John Counter BlvdON, Kitchener - 30 Manitou Dr. Unit EON, London - 663 Wellington Rd.ON, Mississauga - 3190 Ridgeway Dr Unit 12ON, Newmarket - 220 Pony Drive Unit #1BON, Niagara On The Lake - 360 York Rd. Unit #7ON, North Bay - 191 Booth Rd Unit #9ON, North York - 874 Magnetic Dr.ON, Ottawa - 3252 Hawthorne RoadON, Petawawa - 2827 Petawawa BlvdON, Peterborough - 675 The Queensway Unit CON, Pickering - 1600 alliance roadON, Sault Ste. Marie - 105 Black RoadON, Smiths Falls - 236 LombardON, Thunder Bay - 707 Memorial avenueON, Timmins - 407 WilsonON, Windsor - 1660 Huron Church RdQC, Acton Vale - 1124 Rue BoulayQC, Alma - 2685 Avenue du Pont SudQC, Amos - 91 Rue Principale SudQC, Baie-comeau - 930 Rue ComtoisQC, Beloeil - 276 Boulevard Sir-Wilfrid-LaurierQC, Blainville - 1444-A Boulevard Curé-LabelleQC, Boucherville - 1580 Boulevard de MontarvilleQC, Bromont - 1 Chemin des CarrièresQC, Brossard - 6135 Boulevard TaschereauQC, Brownsburg-chatham - 260 Rue des ÉrablesQC, Chambly - 965 Boulevard de PérignyQC, Chateauguay - 315 Boul. IndustrielQC, Chibougamau - 581 3e RueQC, Chicoutimi - 985 Rue ChabanelQC, Cowansville - 360 rue RivièreQC, Dolbeau-mistassini - 283 8e AvenueQC, Dorval - 733 Meloche AveQC, Drummondville - 1250 Boulevard LemireQC, Drummondville - 650 rue DominoQC, Fermont - 451 Rue Le CarrefourQC, Gaspe - 164 Boulevard de GaspéQC, Gatineau - 495 St-René Est, Unité 8QC, Gatineau - 801 Boulevard Maloney EstQC, Granby - 1015 Rue PrincipaleQC, Granby - 1160 Rue PrincipaleQC, Havre-saint-pierre - 1232 Boulevard de l'escaleQC, Jonquiere - 3320 Boulevard St-FrancoisQC, L'ancienne-lorette - 6420 Blvd HamelQC, L'etang-du-nord - 62 chemin ChiassonQC, La Baie - 2005 Boulevard de la Grande Baie NordQC, La Malbaie - 1950 Boulevard de ComportéQC, La Sarre - 289 2e rue EstQC, La Tuque - 947 Boulevard DucharmeQC, Lasalle - 1870 Avenue DollardQC, Laval - 20 Boulevard Cartier OuestQC, Laval - 1650 Boulevard des LaurentidesQC, Laval - 1740 Boulevard Curé-LabelleQC, Les Escoumins - 379 Route 138QC, Levis - 72 Route du Président-KennedyQC, Levis - 4505 Boulevad Guillaume-CoutureQC, Longueuil - 2425 Chemin de ChamblyQC, Longueuil - 1055 Boulevard Curé-Poirier OuestQC, Lourdes-de-joliette - 2181 QC-131, Lourdes-de-Joliette, QCQC, Magog - 2572 Rue SherbrookeQC, Mandeville - 195 rue DesjardinsQC, Mansfield - 219 rue PrincipaleQC, Matane - 1650 Avenue du Phare OuestQC, Matane - 484 Avenue du Phare EstQC, Mercier - 1-200 Boulevard St-Jean-BaptisteQC, Mirabel - 11365 Montee Ste-Marianne, suite 300QC, Mont-laurier - 1212 Boulevard Dr. Albiny-PaquetteQC, Mont-saint-hilaire - 733 Boulevard Sir-Wilfrid-LaurierQC, Mont-tremblant - 354 Rue Magloire GosselinQC, Montreal - 4100 Rue Jarry EstQC, Montreal - 3255 Crémazie EstQC, Nantes - 2737 Rue LavalQC, Papineauville - 205 Rue Henri BourassaQC, Pierrefonds - 14301 Boulevard PierrefondsQC, Pointe-a-la-croix - 56 Boulevard InterprovincialQC, Pointe-aux-trembles - 12255 Rue Sherbrooke EstQC, Quebec - 5590 Rue des TenaillesQC, Quebec - 13044 Boulevard Henri-BourassaQC, Quebec - 1798 rte de l'AéroportQC, Quebec - 265 rue SeigneurialeQC, Quebec - 800 Boulevard Charest OuestQC, Rawdon - 3452 rue albertQC, Repentigny - 332 Rue Notre-DameQC, Rimouski - 458 Boulevard Saint-Germain OuestQC, Rimouski - 55 Boulevard Ste-AnneQC, Riviere-du-loup - 269 Rue TemiscouataQC, Roberval - 488 Boulevard MarcotteQC, Rouyn-noranda - 1081 Avenue LarivièreQC, Saint-apollinaire - 312 Rue LaurierQC, Saint-augustin-de-desmaures - 3587 Rue de L'HêtrièreQC, Saint-constant - 92 Rue Saint-PierreQC, Saint-eustache - 461 Boulevard Arthur-SauvéQC, Saint-felicien - 995 Boulevard HamelQC, Saint-georges - 9045 Boulevard LacroixQC, Saint-hyacinthe - 2995 Rue DessaullesQC, Saint-hyacinthe - 2530 Boulevard Laurier EstQC, Saint-jean-port-joli - 452 Route de l'ÉgliseQC, Saint-jean-sur-richelieu - 175 Boulevard Saint-LucQC, Saint-jean-sur-richelieu - 470 Boulevard Séminaire NordQC, Saint-jerome - 964 Rue LabelleQC, Saint-laurent - 2600 Boulevard PitfieldQC, Saint-leonard - 7226 Blvd LangelierQC, Saint-malachie - 1204 Route HendersonQC, Saint-raymond - 599 Côte-JoyeuseQC, Saint-sauveur - 2252 Chemin Jean-AdamQC, Sainte-adele - 1386 Boulevard de Ste-AdèleQC, Sainte-agathe-des-monts - 1360 Rue Principale EstQC, Sainte-anne-des-monts - 457 Boulevard Sainte-Anne OuestQC, Sainte-catherine - 4400 Route 132QC, Sainte-julie - 1400 Rue Principale, local 201QC, Sainte-julienne - 2065 route 125QC, Sainte-marie - 1029 Boulevard Vachon NordQC, Sainte-therese - 331 Blvd Curé LabelleQC, Salaberry-de-valleyfield - 1765 Boulevard Monseigneur-LangloisQC, Schefferville - 168 Rue des MontagnaisQC, Sept-iles - 646 Boulevard LaureQC, Sherbrooke - 1091 13e Avenue NordQC, Sherbrooke - 2700 Rue King O, Local 2QC, Sherbrooke - 1910 12e Avenue NQC, Sherbrooke - 1685 Rue DenaultQC, Sherbrooke - 4255 Boulevard BourqueQC, Sorel-tracy - 1760 Boulevard FisetQC, Temiscouata-sur-le-lac - 704 Rue Commerciale NordQC, Terrebonne - 1989 Chemin GasconQC, Thetford Mines - 970 Boulevard Frontenac OuestQC, Thurso - 445 rue VictoriaQC, Trois-rivieres - 5250 Boulevard Jean-XXIIIQC, Trois-rivieres - 6085 Boulevard Gene-H.-KrugerQC, Trois-rivieres - 1180 Boulevard ThibeauQC, Val-d'or - 1150 Rue de l'EscaleQC, Varennes - 2276 Route Marie-VictorinQC, Vaudreuil-dorion - 711 route Harwood Local 120QC, Victoriaville - 900 Rue Notre-Dame EstQC, Victoriaville - 1010 Boulevard Jutras EstSK, Davidson - 1204 Railway StSK, Kerrobert - 545 Railway AveSK, Kindersley - 819 9 St WSK, La Ronge - 704 Finlayson StreetSK, Laflèche - SK-13SK, Midale - SW-19-5-11-W2nd Hwy 606 WSK, Moose Jaw - 365 River Street West, Unit 133SK, Moosomin - 1102 Park AveSK, Nipawin - 101 West Spruce AveSK, North Battleford - 1731 100th StreetSK, Prince Albert - 524 B, 16 Street WestSK, Regina - 4X1, 156 1 Ave ESK, Saskatoon - 825 46th St ESK, Swift Current - 127 8 Avenue North WestSK, Watson - NW-21-38-17 West of the 2ndSK, Yorkton - 465 Broadway Street EastPlease refer to the locations page for a visual geographical reference.Preferred Installation DateIt is important that you allow a minimum of two (2) business days to obtain an appointment through this form. The appointment must be confirmed by our Service center and may differ from your requested date. No appointment on Saturdays may be scheduled through this form. Date Format: YYYY dash MM dash DD MorningAfternoonConditionsWhat is your arrest date?* Date Format: YYYY dash MM dash DD Where have you been sentenced?*What is the length of your term?*Vehicle InformationVehicle Year*Vehicle Make*Vehicle Model*Vehicle Start Type*-- Select --Push ButtonTurn KeyVehicle Colour*Vehicle Identification Number (VIN)*License Plate Number*CommentsThis field is for validation purposes and should be left unchanged.