Smart Start Canada – Québec Install Form

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 program
Transitioning participant from a different supplier

NOTE: 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 appointment
No, I did not receive it yet

We cannot proceed with the creation of your file. Please contact us upon receiving it.

Do you have a removal appointment?*

Yes, I have a removal appointment. See below.
No, I do not have a removal appointment

Removal Date*

Removal Time*

We cannot proceed with the creation of your file. 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)

Restricted
Condition I
Condition X
Condition ICA

Personal Information

First Name*

Middle Name

Last Name*

Date of Birth*

Telephone Number*

Alternate Phone Number

Can 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*

Address

Street Address*

City/Town*

Province

Country

Postal Code*

Installation

Preferred Service Centre*

Please refer to the locations page for a visual geographical reference.

Preferred Installation Date

It 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.

Morning
Afternoon

Conditions

What is your arrest date?*

Where have you been sentenced?*

What is the length of your term?*

Vehicle Information

Vehicle Year*

Vehicle Make*

Vehicle Model*

Vehicle Start Type*

Vehicle Colour*

Vehicle Identification Number (VIN)*

License Plate Number*

Name

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

Western/Central Canada: (844) 432-4776

Province of Québec: (844) 282-8300

Québec Install Form

Please allow 2 business days to receive your response.

Personal Information

Address

Installation

Conditions

Vehicle Information

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Western/Central Canada: (844) 432-4776

Province of Québec: (844) 282-8300