If your customer has a Monitech Ignition Interlock device installed in their vehicle, please fill out the form below and a mechanic’s code will be provided to you so you can safely complete the needed repairs. Please be sure to complete the entire form.

This form is to be completed only by the ASE-certified mechanic performing the work. Once submitted, Monitech will review all information and if there are questions, you may be asked to provide additional information.

TO BE COMPLETED BY MECHANIC SHOP ONLY

Step 1 of 5

Customer Information
All customer information must be for the individual who the ignition interlock is assigned to.
Customer's Name*
First Last
The name of the ignition interlock program participant.
Customer's Phone Number*
Customer's Email Address (Optional)
Representative name (If known)?

Vehicle Information
A description of the section goes here.
Vehicle Year, Make, and Model*

Mechanic Information
Shop Name*
Service Advisor*
Shop Phone Number*
Shop Address*
Street Address Address Line 2 City State ZIP Code

Date Work is to be Performed
Please enter the date(s) you will be working on the vehicle. Please note, we only provide a maximum of 2 days worth of codes. If you will need to work on the vehicle more than 2 days, you will need to call us on day 3 for additional codes.
Work Date (From)*
MM slash DD slash YYYY

Please enter the date you will begin working on the vehicle.
Work Date (To)*
MM slash DD slash YYYY

Please enter the date you will finish working on the vehicle.
What type of work will be performed?*
If you are not in NC and are requesting information to perform a removal, additional information is required. Please complete the form, and have the customer contact us for further instructions.
Shop Verification
Please confirm that your shop is ASE certified. Monitech only provides mechanic codes to ASE certified mechanics. We'll also need a copy of the customer's invoice/work order.
Is your shop ASE certified?*

Mechanic Agreement
All fields MUST be checked in order to be assisted.
Please Agree to the following*
- I understand and agree to all of the below.
I, or my coworkers will be in sole possession of the above mentioned vehicle during the date(s) stated above

I state under penalty and perjury that the information stated above in this form is true and correct.

I hereby attest that I will be performing service on the vehicle listed above. I understand that unless the customer will be in the vehicle to operate the interlock device the entire time work is being performed, that I will need a mechanic’s code from Monitech along with instructions prior to working on the vehicle. (The code and will be provided once the completed form has been received and processed. The instructions will be available online upon completion of this form.)

I will not provide the mechanic code(s) to the customer or anyone in their party, nor will I provide them with copies of the instructions.

All fields MUST be checked in order to be assisted.

Step 1 of 5

Customer Information

Vehicle Information

Mechanic Information

Date Work is to be Performed

Shop Verification

Mechanic Agreement