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)?

Step 1 of 5

Customer Information

Vehicle Information

Mechanic Information

Date Work is to be Performed

Shop Verification

Mechanic Agreement

Mechanic Code Request

Step 1 of 5

Customer Information

Vehicle Information

Mechanic Information

Date Work is to be Performed

Shop Verification

Mechanic Agreement