Incident Report

Incident Report Form

Use this form to request a credit of lockout fees, or to request a credit or reimbursement of charges (receipt required).

"* (required)" indicates required fields

Comments

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 the violation in question has been reset and my device serviced within the last 60 days at my local service center. 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 Speed Aware device. Please understand your state authority oversees the Intelligent Speed Assistance program and your state certifies all Speed Aware devices.

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

Speed Exceedance Violation
Power Loss
Tampering or Bypass Attempt
Service Lockout – Missed Appointment

If your violation recall condition or service lockout was caused by one of the above events, a credit or reimbursement, as applicable, will not be issued.

Credits and reimbursements will not be issued when the violation is determined to be user error. There are limited exceptions to this rule.

A certified Speed Aware device must enter into a violation recall after the following events:

Speed Exceedance Violation
Power Loss
Tampering or Bypass Attempt
Service Lockout – Missed Appointment

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.

This field is hidden when viewing the form

Section Break

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