Get Wa Dr-500-011 2017-2026

The WA DR-500-011 form is used by out-of-state ignition interlock companies to report ignition interlock activity. This guide provides clear, step-by-step instructions to help you complete the form online efficiently and accurately.

Follow the steps to fill out the WA DR-500-011 form online.

1. Click the 'Get Form' button to access the WA DR-500-011 and open it in the online editor.
2. Begin by entering the driver's name in the format Last, First, Middle initial. Ensure clarity by printing or typing the information.
3. Input the driver's date of birth and driver license number in the designated fields.
4. Fill in the mailing address of the driver, including the city, state, and ZIP code.
5. For the activity section, check one box only that corresponds to the activity being reported, such as installation, compliant, non-compliant/non-functioning, removal, or compliance release. Include the relevant date next to the selected activity.
6. Indicate if any incidents have occurred within the specified time frame. Make sure to include details if there have been any attempts to start the vehicle with a breath alcohol concentration of .04 or more, or any missed vendor appointments.
7. Next, provide details about the vehicle, including make/model, year, vehicle identification number (VIN), and license plate number.
8. Fill in the device number related to the ignition interlock system.
9. Complete the company section by typing or printing the ignition interlock company name and provide the Washington business license number.
10. Add the name of the company representative and phone number, ensuring to include the area code.
11. Finally, include the mailing address of the company, including city, state, and ZIP code.
12. Once all fields are filled out, save your changes, download the completed form, print it for submission, or share it as needed.

Complete your WA DR-500-011 form online today to ensure timely and accurate reporting.