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Intoxalock Ignition Interlock Device Information Form

Please complete the form to enroll in the ignition interlock process with one of the state-approved providers, Intoxalock. Once complete, click SUBMIT at the bottom of the page. For more information, please call 866-604-5247 for immediate assistance. 

By clicking the button, I am providing my ESIGN signature and express written consent to permit Consumer Safety Technology, LLCConsumer Safety Technology, LLC brands include Intoxalock, Keepr, DUI.org, DUICare, and parties calling on its behalf, to contact me at the number provided above, without regard to the time of day, for marketing purposes, including through the use of automated technology, SMS/MMS messages, and prerecorded and/or artificial voice messages. Consent is not a condition of purchase. For California residents, click here.

NOTE: Upon receipt of form, state-approved provider will contact applicant via phone for further processing. Receipt of this form does not guarantee fulfillment of obligation to install an ignition interlock device. Monthly service fees, installation fees and taxes may apply.