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Time & Temp 321-2522

Other, Describe

Speeding Ticket?

How Fast? (E.G. 45 in a 20)

Other types of tickets

Violation of Traffic Control Device (stop light, stop sign, etc.)

Following too closely

Driving While Intoxicated

Careless Driving

Other, Describe

 CONTACT INFORMATION

Salutation --   Mr. Mrs. Miss Ms.

LAST NAME                      FIRST NAME                    M.I.

E-MAIL ADDRESS                                YOUR DATE OF BIRTH

I would prefer you contact me at:

Home Telephone Work Telephone Cell Phone E-Mail

Home Telephone                           Work Telephone

Cell Phone Number                        Other

Address As Written On The Ticket

Number  Street Name

City    State Alabama Arkansas California Colorado Delaware Florida Illinois Indiana Kansas Kentucky Louisiana Michigan Missouri Nebraska New Jersey New Mexico New York Nevada North Carolina Ohio Oklahoma South Carolina Tennessee Texas Utah Virginia Washington West VA Wyoming Zip

Is the address that is written on the ticket your correct MAILING address?    Yes, It Is Correct   No, My Mailing Address Is:

Number  Street Name

City    State Alabama Arkansas California Colorado Delaware Florida Illinois Indiana Kansas Kentucky Louisiana Michigan Missouri Nebraska New Jersey New Mexico New York Nevada North Carolina Ohio Oklahoma South Carolina Tennessee Texas Utah Virginia Washington West VA Wyoming Zip

INFORMATION ABOUT THIS TICKET

 
NAME OF THE POLICE DEPARTMENT that gave you the ticket(s)?
 

Did the alleged offense occur within a construction zone or a school zone?

No Yes  If Yes, Explain

List ALL tickets, that occurred with THIS TRAFFIC STOP. The TICKET NO. is usually in RED and is in the upper right hand corner of the ticket you received.

1st Ticket No.   Description

2ndTicket No.   Description

3rd Ticket No.   Description

OTHER CHARGES

More than 3 tickets OR I was charged with other offenses, Describe:

Was there an accident involved?

No

Yes, Describe:

Court Name (Answer required:  If you don't know, type "don't know")

COURT ADDRESS (City, State Zip). This is usually found in the bottom right-hand portion of the ticket.

Number  Street Name

City    State Alabama Arkansas California Colorado Delaware Florida Illinois Indiana Kansas Kentucky Louisiana Michigan Missouri Nebraska New Jersey New Mexico New York Nevada North Carolina Ohio Oklahoma South Carolina Tennessee Utah Virginia Washington West VA Wyoming Zip

COURT PHONE NUMBER 

If there is a court date and time written on your ticket what are they?  DATE  TIME

IF no court date and time is listed, give us the date on which the ticket was "issued". (This is usually in the upper left hand corner of the ticket).  "ISSUED ON"

Your statement or comments about the ticket

INFORMATION ABOUT YOUR DRIVING RECORD

Any tickets in the last 12 months?  No Yes

Do you have any charges NOW PENDING in this or any other court?  No Yes  If Yes, Fill In:

Currently on Probation for other offenses?  No Yes

License Suspended or Revoked?  No Yes

After you send us your ticket information, our staff will contact you in short order about your case.   You can decide if you wish to pay by credit card, check, or cash.

This web site is designed for general information only. The information presented at this site should not be construed to be formal legal advice nor the formation of a lawyer/client relationship.