Defendant First name

Defendant Last name

D.O.B. (DD/MM/YYYY)

Case #

Phone

Address

Vehicle Yr/Make/Model

Court Contact Name

Court

Court Contact Email

Condition of: Condition of: Bond Probation Other

Other:

Please confirm service(s) being ordered: Please confirm service(s) being ordered: GPS Services Alcohol Monitoring Ignition Interlock w/ Camera Vehicle Immobilization

GPS Tether GPS Tether Smart Tag Tether Check-In App

Alcohol Monitoring Alcohol Monitoring AlcoTag Tether AlcoTag Tether - Activate GPS Monitoring SmartMobile - Basic SmartMobile - Cellular

Ignition Interlock Additional Services Ignition Interlock Additional Services Add Daily Testing Add Cellular Modem

Defendant must start the program by: (DD/MM/YYYY)

Program Length:

For standard IID, how often must the defendant have the device downloaded? For standard IID, how often must the defendant have the device downloaded?WeeklyBi-weeklyMonthlyBi-monthly

Special Intructions/Comments:

For required PBTs on Interlock, specify two daily test windows. Ex. 1. 5am-8am 2. 10pm-12am

SmartMobile and Check-In Instructions Devices can be programmed with up to 10 test windows a day. The test windows can be set as random or known by the defendant. If windows change daily, please list schedule below: Mon-Sun SmartMobile and Check-In Instructions Devices can be programmed with up to 10 test windows a day. The test windows can be set as random or known by the defendant. If windows change daily, please list schedule below: Mon-Sun Standard Default Times (Mon - Sun: 5am–8am, 5pm–8pm, & 10pm–12am) Custom Test Times (List Below)

Custom Test Times (To set a Random Test window, put an "R" in front of each random test time. Ex. Mon - R 12pm-3pm)