Smart Start Canada – Yukon Install Form

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.

Personal Information

First Name (required)*
Middle Name
Last Name (required)*
Date of Birth (required)*
YYYY dash MM dash DD
Cell Phone Number (required)*
Home Phone Number
Email Address (required)*
Driver's License Number (required)*

Address

Street Address (required)*
City/Town (required)*
Hidden
Province
Hidden
Country
Postal Code (required)*

Additional Info

Next of Kin (Name - Relation)
Next of Kin Phone Number

Installation

Preferred Installation Date
Please provide a minimum of 2 days from the current date. Please do not request Saturday or Sunday, the appointment may not be honored.
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- Morning
- Afternoon
Secondary Installation Date
Please provide a minimum of 3 days from the current date. Please do not request Saturday or Sunday, the appointment may not be honored.
YYYY dash MM dash DD
- Morning
- Afternoon

Vehicle Information

Vehicle Year (required)*
Vehicle Make (required)*
Vehicle Model (required)*
Vehicle Start Type (required)*
Vehicle Colour (required)*
Vehicle Identification Number [VIN] (required)*
License Plate Number (required)*
Additional Notes
This can be used for additional details, e.g., you are hearing impaired and require a light-indicator for device notifications in the car, etc.

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

Smart Start will only share information with the client unless the client is under 18 years old. No information will be given to immediate family or a 3rd party. In the event that a minor requires interlock, then a signature from a guardian is required. Also, a guardian is required to be at the installation and removal of the interlock for anyone under 18 years old.

Contact Us Today

Western/Central Canada: (844) 432-4776

Province of Québec: (844) 282-8300